Search

Anxiety disorders are common, debilitating, and begin early in life. Early intervention to prevent anxiety disorders in children who are at risk could have long-term impact. The ‘Cool Little Kids’ parenting group program has previously been shown to be efficacious in preventing anxiety disorders in temperamentally inhibited young children. Wider dissemination of the program could be achieved with an internet-based delivery platform, affording greater accessibility and convenience for parents. The aim of this study was to evaluate ‘Cool Little Kids Online’, a newly developed online version of the existing parenting group program. Fifty-one parents of children aged 3–6 years were recruited to evaluate the online program's acceptability and preliminary efficacy in reducing inhibited young children's anxiety problems. Parents were randomized to receive either a clinician-supported version or an unsupported version of the program. Parents had 10 weeks to access the program and completed questionnaires at baseline and post-intervention. Both groups showed medium-to-large reductions in children's anxiety symptoms, emotional symptoms, number of child anxiety diagnoses, and improvements in life interference from anxiety. The effect of clinician support was inconsistent and difficult to interpret. Parents reported high levels of satisfaction with the program. These encouraging results indicate that the online version is acceptable and useful for parents with temperamentally inhibited young children. Cool Little Kids Online may be a promising direction for improving access to an evidence-based prevention and early intervention program for child anxiety problems. A large randomized trial is warranted to further evaluate efficacy., Highlights • An online version of an existing parenting program for child anxiety was developed. • Most parents found the program useful, user-friendly, and would recommend it. • A clinician-supported format was not clearly superior to a self-guided format.

Objectives Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Design Cluster-randomised controlled trial. Setting 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). Participants English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. Intervention WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Main outcome measures Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. Results In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. Conclusions WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. Trial registration number ACTRN12613000506796; Results.

Public health advocates have highlighted internalising problems as a leading cause of global burden of disease. Internalising problems (anxiety/depression) affect up to 20% of school-age children and can impact peer relations, school engagement and later employment and mortality. This translational trial aimed to determine whether a selective/indicated parenting group programme to prevent internalising distress in shy/inhibited preschool children had sustained effects in middle childhood. Translational design aspects were a brief parent-report screening tool for child inhibition offered universally across the population via preschools in the year before school, followed by an invitation to parents of all inhibited children to attend the parenting programme at venues in their local community.Design of the study was a randomised controlled trial. The setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited four-year-old children of which 456 (84%) were retained during middle childhood (age of seven to 10 years). Early intervention was the Cool Little Kids parenting group programme, and control was 'usual care' access to available support services in the community. Primary outcomes were child anxiety and depression symptoms (parent and child report) and DSM-IV anxiety disorders (assessor masked). Secondary outcomes were parenting practices and parent mental health.There was no significant difference in anxiety disorders between the intervention and control group during the three annual follow-ups of the cohort in middle childhood (2015 43% vs. 41%, 2016 40% vs. 36%, 2017 27% vs. 30%, respectively; p's .05). There were also no significant differences in child anxiety or depression symptoms (by child or parent report), parenting practices or parent mental health, between the intervention and control group during middle childhood. However, a priori interaction tests suggested that for children with anxious parents, early intervention attenuated risk for middle childhood internalising problems.An issue for population translation is low levels of parent engagement in preventive interventions. Initial effects of the Cool Little Kids parenting group programme in reducing shy/inhibited preschool children's internalising distress at school entry dissipated over time, perhaps due to low engagement. Future translational research on early prevention of internalising problems could benefit from screening preschool children in the population at higher risk (combining temperamental inhibition and parent distress) and incorporating motivational techniques to facilitate family engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662.

Background The aim was to determine outcomes in the first year of school of a population-delivered parenting program to prevent internalising problems in temperamentally inhibited preschool children and predictors of engagement in parenting groups. Method Design: Randomised controlled trial. Setting 307 preschool services across eight socio-economically diverse government areas in Melbourne, Australia. Participants 545 parents of inhibited 4-year-old children; 469 (86%) retained at two-year follow-up. Intervention Cool Little Kids program. Primary outcomes were child internalising symptoms and anxiety disorders. Secondary outcomes were parenting, parent well-being and engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662. Results In the first year of school (M (SD) age 6.7 (0.4) years), child anxiety symptoms were reduced in the intervention versus control arm (PAS-R M (SD): total 36.2 (17.2) versus 39.4 (18.5); adjusted difference -3.26, 95% CI -6.46 to -0.05, p = .047; specific fears 9.1 (6.2) versus 10.7 (6.8), adjusted difference -1.53; 95% CI -2.69 to -0.38, p = .009). However, there was little difference in broader child internalising (CMFWQ M (SD): 2.2 (0.5) versus 2.3 (0.6); adjusted difference -0.03, 95% CI -0.13 to 0.06, p = .489) or anxiety disorders (37.6% vs. 42.6%; adjusted OR 0.79, 95% CI 0.53 to 1.18, p = .242). Lower income, younger mothers, less educated and more culturally diverse fathers engaged less with the intervention. Continued skills practice was less frequent for parents of girls and in advantaged neighbourhoods. Conclusions There were population effects of Cool Little Kids in the first year of school for anxiety symptoms but not disorders. Considering motivation techniques to engage subgroups of families would be helpful in translation research.

Objective A translational trial evaluated the effectiveness of screening for inhibited childhood temperament, followed by a preventive parenting program -Cool Little Kids. This study determined the cost-effectiveness from societal and health sector perspectives using trial data. Method Resources to deliver the screening and parenting sessions were determined from study records. Parents completed a questionnaire reporting resources used at one-year follow-up. Standard Australian unit costs were applied. Clinical outcomes for children and parental quality adjusted life-years (QALYs) were used to calculate incremental cost-effectiveness ratios (ICERs). Results Total societal costs were lower, but non-significant for the intervention compared to the control group (mean difference -$500 p = 0.937). Total health sector costs were significantly greater (mean difference $1,956; p = 0.015). The intervention led to significantly fewer internalising symptoms (Strengths and Difficulties Questionnaire (SDQ)-emotional difficulties adjusted mean difference −0.5; p = 0.006), fewer children with SDQ-emotional symptoms in the abnormal range (24.2 % vs. 33.0 % p = .014) and fewer with diagnosed anxiety (44.2 % vs. 50.2 % p = 0.427). From the societal perspective, the intervention would likely be cost-effective. Health sector ICERs were $1,171/SDQ-emotional symptom decrease, $51/abnormal SDQ avoided and $77/anxiety case avoided. Conclusions This economic analysis alongside an implementation study provides an early indication that Cool Little Kids may be cost-effective.

Natural feed additives are used to maintain health and to promote performance of pigs without antibiotics. Effects of a probiotic, inulin, and their combination (synbiotic), on the microbial diversity and composition at different intestinal locations were analysed using denaturing gradient gel electrophoresis (DGGE), real-time PCR, and 16S rRNA gene pyrosequencing. Bacterial diversity assessed by DGGE and/or pyrosequencing was increased by inulin in all three gut locations and by the synbiotic in the caecum and colon. In contrast, the probiotic did only affect the microbiota diversity in the ileum. Shifts in the DGGE microbiota profiles of the caecum and colon were detected for the pro- and synbiotic fed animals, whereas inulin profiles were more similar to the ones of the control. 16S rRNA gene pyrosequencing revealed that all three additives could reduce Escherichia species in each gut location, indicating a potential beneficial effect on the gut microbiota. An increase of relative abundance of Clostridiaceae in the large intestine was found in the inulin group and of Enterococcaceae in the ileum of probiotic fed pigs. Furthermore, real-time PCR results showed that the probiotic and synbiotic increased bifidobacterial numbers in the ileum, which was supported by sequencing results. The probiotic and inulin, to different extents, changed the diversity, relative abundance of phylotypes, and community profiles of the porcine microbiota. However, alterations of the bacterial community were not uniformly between gut locations, demonstrating that functionality of feed additives is site specific. Therefore, gut sampling from various locations is crucial when investigations aim to identify the composition of a healthy gut microbiota after its manipulation through feed additives.

OBJECTIVE Prevention of child behavior problems may reduce later mental health problems. We compared the effectiveness, at the population level, of an efficacious targeted prevention program alone or following a universal parenting program. METHODS Three-arm, cluster randomized controlled trial. One thousand three hundred fifty-three primary caregivers and healthy 8-month-old babies recruited from July 2010 to January 2011 from well-child centers (randomization unit). PRIMARY OUTCOME Child Behavior Checklist (CBCL) externalizing and internalizing scales* at child ages 3 and 4.5 years. SECONDARY OUTCOMES Parenting Behavior Checklist* and over-involved/protective parenting (primary caregiver report). Secondary caregivers completed starred measures at age 3. RESULTS Retention was 76% and 77% at ages 3 and 4.5 years, respectively. At 3 years, intention-to-treat analyses found no statistically significant differences (adjusted mean difference [95% confidence interval (CI); p-value]) for externalizing (targeted vs usual care -0.2 [-1.7 to 1.2; p = .76]; combined vs usual care 0.4 [-1.1 to 1.9; p = .60]) or internalizing behavior problems (targeted vs usual care 0.2 [-1.2 to 1.6; p = .76]; combined vs usual care 0.4 [-1.1 to 2.0; p = .58]). Primary outcomes were similar at 4.5 years. At 3 years, primary and secondary caregivers reported less over-involved/protective parenting in both the combined and targeted versus usual care arm; secondary caregivers also reported less harsh discipline in the combined and targeted versus usual care arm. Mean program costs per family were A$218 (targeted arm) and A$682 (combined arm). CONCLUSION When translated to the population level by existing staff, pre-existing programs seemed ineffective in improving child behavior, alone or in combination, but improved parenting.

Objective: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. Methods: Design: a randomised controlled trial was used. Setting: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. Secondary outcomes: the secondary outcomes were parenting practices and parent mental health. Results: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal – 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms – mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = –0.47, 95% confidence interval = [–0.81, –0.13], p = 0.006). Parents’ participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. Conclusion: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood.

Background/aims Achieving a high response rate to follow-up questionnaires in randomized controlled trials of interventions is important for study validity. Few studies have tested the value of incentives in increasing response rates to online questionnaires in clinical trials of health interventions. This study evaluated the effect of a gift card prize-draw incentive on response rates to follow-up questionnaires within a trial of an online health intervention. Method The study was embedded in a host randomized controlled trial of an online parenting program for child anxiety. A total of 433 participants were randomly allocated to one of two groups: (1) being informed that they would enter a gift card prize-draw if they completed the final study questionnaire (24-week follow-up) and (2) not informed about the prize-draw. All participants had a 1 in 20 chance of winning an AUD50 gift card after they completed the online questionnaire. Results The odds of the informed group completing the follow-up questionnaire were significantly higher than the uninformed group, (79.6% vs 68.5%, odds ratio = 1.79, 95% confidence interval = 1.15–2.79). This response rate increase of 11.1% (95% confidence interval = 2.8–19.1) occurred in both intervention and control groups in the host randomized controlled trial. The incentive was also effective in increasing questionnaire commencement (84.6% vs 75.9%, odds ratio = 1.74, 95% confidence interval = 1.07–2.84) and reducing the delay in completing the questionnaire (19.9 vs 22.6 days, hazard ratio = 1.34, 95% confidence interval = 1.07–1.67). Conclusion This study adds to evidence for the effectiveness of incentives to increase response rates to follow-up questionnaires in health intervention trials.

Temperamental inhibition has been identified as a key risk factor for childhood anxiety and internalizing problems. An efficacious early prevention programme for shy/inhibited children has been developed; however, accurate, efficient and acceptable screening is needed to support wider implementation. We explore community screening options in the context of a trial implementing the Cool Little Kids prevention programme for anxiety disorders. In comparison to the Australian Temperament Project's inhibition scale, we examine the Strengths and Difficulties Questionnaire's (SDQ) ability to screen for inhibited preschool children. Parents of 6307 children aged 3 to 6 years enrolled in preschool programmes from eight socio-economically diverse districts in Melbourne, Australia, first completed the measures of inhibition and SDQ. Parents with inhibited children then enrolled in the Cool Little Kids randomized trial (n = 545). Of these, 88% provided feedback about inhibition screening. Parents allocated to the intervention also provided feedback on the Cool Little Kids parenting programme. Results demonstrated that parents of preschool children (i) find inhibition screening acceptable, (ii) take up this parenting programme and (iii) report favourable feedback. The SDQ emotional symptoms subscale demonstrated acceptable sensitivity but insufficient specificity to identify inhibited preschool children. Presenting parents with a brief, validated inhibition scale could be a low-cost option for identifying inhibited preschool children in the community to offer early anxiety prevention. Copyright © 2014 John Wiley & Sons, Ltd.

Objective Describe parent-reported child eating behaviour and maternal parenting impact outcomes of an infant feeding intervention to reduce child obesity risk. Design and Methods An assessor masked Randomised Controlled Trial (RCT) with concealed allocation of individual mother-infant dyads. The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 months (SD=1.0) at baseline. Outcomes were assessed six months post-intervention when the children were 2-years old. Mothers reported on child eating behaviours using the Child Eating Behaviour Questionnaire (CEBQ), food preferences and dietary intake using a 24-hour telephone recall. Parenting was assessed using five scales validated for use in Australia. Results Intervention effects were evident on the CEBQ overall (MANOVA P=.002) and 4/8 subscales: child satiety responsiveness (P=.03), fussiness (P=.01), emotional overeating (P

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system. Design: Cluster randomised trial. Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia. Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003. Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care. Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs. Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference −1.4 (−2.3 to −0.4) and 12 months (−1.7 (−2.6 to −0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively. Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system. Trial registration: Current Controlled Trial Registry, number ISRCTN48752250 (registered November 2004).

Background Anxiety disorders are the most common type of mental health problem and begin early in life. Early intervention to prevent anxiety problems in young children who are at risk has the potential for long-term impact. The ‘Cool Little Kids’ parenting group program was previously established to prevent anxiety disorders in young children at risk because of inhibited temperament. This group program was efficacious in two randomised controlled trials and has recently been adapted into an online format. ‘Cool Little Kids Online’ was developed to widen and facilitate access to the group program’s preventive content. A pilot evaluation of the online program demonstrated its perceived utility and acceptability among parents. This study aims to evaluate the efficacy of Cool Little Kids Online in a large randomised controlled trial. Methods/Design Parents of young children who are 3–6 years old and who have an inhibited temperament will be recruited (n = 385) and randomly assigned to either immediate access to Cool Little Kids Online or delayed access after a waiting period of 24 weeks. The online program contains eight modules that help parents address key issues in the development of anxiety problems in inhibited children, including children’s avoidant coping styles, overprotective parenting behaviours, and parents’ own fears and worries. Intervention participants will be offered clinician support when requested. The primary outcome will be change in parent-reported child anxiety symptoms. Secondary outcomes will be child internalising symptoms, child and family life interference due to anxiety, over-involved/protective parenting, plus child anxiety diagnoses assessed by using a new online diagnostic tool. Assessments will take place at baseline and 12 and 24 weeks after baseline. Discussion This trial expands upon previous research on the Cool Little Kids parenting group program and will evaluate the efficacy of online delivery. Online delivery of the program could result in an easily accessible evidence-based resource to help families with young children at temperamental risk for anxiety disorders. Trial registration Australian New Zealand Clinical Trials Registry 12615000217505 (registered 5 March 2015) Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1022-5) contains supplementary material, which is available to authorized users.

During cooling from the quiescent melt of a highly oriented polyethylene rod, highly oriented proto-lamellae are formed first, which are not crystalline. This is shown in scattering data which are recorded on two-dimensional detectors with a cycle time of 1 s and an exposure of 0.1 s. In the experiments small-angle X-ray scattering (SAXS) and wide-angle X-ray scattering (WAXS) are registered simultaneously during the first 3 min after quenching to a crystallization temperature. A non-uniform thickness between 20 and 100 nm is characteristic for the ensemble of proto-lamellae. During the first minute of isothermal treatment the number of proto-lamellae slowly increases without a change of the thickness distribution. As crystallization starts, the crystallites are not oriented in contrast to the proto-lamellae. During crystallization the layer thickness distribution narrows. The number of lamellae rapidly increases during the following 2 min of isothermal treatment (at 128 degrees C and 124 degrees C). The results are obtained by interpretation of the WAXS and of the multidimensional chord distribution function (CDF), a model-free real-space visualization of the nanostructure information contained in the SAXS data.

8 pags., 13 figs., Completely amorphous, transparent bars of amylopectin were prepared by injection molding of pure native semicrystalline samples (Waxy Maize). The formation of a semicrystalline morphology was studied during annealing treatment at various temperatures in a wet atmosphere, using simultaneous WAXS and SAXS. Amylopectin samples crystallized during 20 days in a humid atmosphere at room temperature and subjected to a successive melting process were also studied by X-ray scattering. Results indicate that individual molecules crystallize independently from each other, similar to the case of native amylopectin grains. During the first stages of crystallization, the changes in the SAXS pattern suggest that uncorrelated crystal blocks are formed, which may arrange to lamellae (if a secondary network of double-helix net-points is hydrothermally dissociated). At the beginning of the crystallization process, only few amylopectin molecules (about 10%) are incorporated into the nanostructure. A shell-like structure of semicrystalline lay ers, comparable to that of a native grain, develops. When crystallization proceeds further, the initially thin shell layers thicken. This causes the amorphous interlayers to be subjected to inner tensions, leading to a decrease in the melt temperature. After a storage time of 20 days in a humid atmosphere, amylopectin reaches a crystallinity level of 54%, only slightly lower than that of the initial native grains. Upon heating the retrograded amylopectin, immediately before complete melting, the long-period shows a value of 15 nm with a crystal thickness, derived from WAXS, of only 4 nm. Such a structure, which has not been reported before, is due to the relaxations of the inner tensions during melting, which lead to a disappearance of inserted interlamellar crystals. © 2006 Wiley Periodicals, Inc., The SAXS and WAXS data discussed in this work were derived from measurements carried out at HASYLAB,DESY, Hamburg, under project II-04 –029 EC. The Arburg Company in Lossburg, Germany is thanked for kind supplyof the injection-molding machine used

Structure evolution of highly oriented polyethylene during cautious melting and crystallization is investigated with both high time resolution and high signal-to-noise ratio by means of small-angle X-ray scattering (SAXS) and wide-angle X-ray scattering (WAXS). The two-dimensional SAXS patterns are transformed to the multidimensional chord distribution function (CDF) in physical space. The results are continuous and smooth movies of the nanostructure, which elucidate the mechanisms of the evolution of semicrystalline structure. We find that in our material crystallization is preceeded by a rather diffuse mesomorphic nanostructure. Based on its variation in relation to other observed features like row nuclei and crystalline lamellae, we propose to associate it to phase separated regions of entangled and disentangled chain segments, respectively. The movies show that the mesophase structure holds the key for the understanding of crystallite orientation and arrangement in the fibre.

Highly oriented high-pressure injection-molded (HPIM) rods from polyethylene (PE) were heated until the discrete small-angle X-ray scattering (SAXS) has vanished. Thereafter, non-isothermal and isothermal crystallization was investigated in situ by means of ultra small-angle X-ray scattering (USAXS). The orientation of the crystallites could be controlled by choice of the melt annealing temperature (shish-kebab model:memory or self-nucleation effect caused by stable shishs). Both the scattering patterns and the multi-dimensional chord distribution function (CDF) were interpreted. A three-stage model of crystallization was also developed. This model comprises row structure nucleation, the almost statistical insertion of extended lamellae and finally the insertion of blocky crystallites. It was found that the nanostructure evolution in the isotropic fraction of the material was the same as in the highly oriented one. The lateral extension of the lamellae was largest during isothermal crystallization. The correlation among domains was increased by non-isothermal crystallization. The shishs in the core of HPIM rod appeared less stable than those in the shell. Lobe-shaped reflections observed during and after quenching were not due to an orientation distribution of layer stacks, but reflected a correlation between long period and lateral extension of crystallites. During quenching, a lateral modulation of the layer peaks in the CDF grew stronger and showed the arrangement of block-shaped crystals proposed by Strobl to the precursors of lamellae. The thin crystals formed during rapid cooling were built from a central block surrounded by one or two rings of satellites. The long period observed in the scattering pattern during quenching is due to correlations among lamellae.

Native starches with wide varying amylose content were processed by injection molding. The injection- molded materials were conditioned in water for 20 days and sealed in glass capillaries. Simultaneous wide- and small- angle X-ray scattering (WAXS and SAXS, respectively) were recorded during thermal heating using a synchrotron source. Crystallinity, SAXS invariant, Q, and long period, L, were measured as a function of heating temperature. The injection-molding process provokes a destruction of the crystal forms A (cereal starch) and B (tubercle starch) but favors a development of the crystal form Vh. After wet conditioning, WAXS of the injection-molded samples shows again the appearance of the crystal forms A or B, and crys- tallinity reaches values similar or larger than those of native starch. A constant heating rate (5°C/min) was particularly used for a comparison of potato and corn starch with a similar amylose content. While the crystallinity associated to forms A and B slowly decreases below 55°C and then rap- idly decreases until its disappearance at 85-90°C, the invari- ant shows a maximum around 40°C and rapidly decreases thereafter. The total nanostructure disappearance occurs at temperatures about 10°C higher for the case of potato starch. In addition, a recovery of the WAXS and SAXS maxima during the subsequent cooling process before reaching room temperature was observed only for potato starch. Analysis of WAXS and SAXS for the rest of the starch materials reveals clear differences in the structural parameters of the samples that cannot be easily explained solely on the basis of the amylose content. Thus, for Cerestar and Roquette, it is noteworthy that there was a continuous decrease of L until its total disappearance as well as the persistence of crystal- linity (form B), presumably stabilized by the presence of the Vh structure (12-15%). Real-time crystallization experiments on two amorphous injection molded samples, waxy maize (free amylose starch) and potato starch, are also discussed. It is shown that the absence of amylose delays the recrystalli- zation of amylopectine during the experiment. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 301-309, 2004

High-pressure injection-molded polyethylene (PE) rods are studied by ultra small-angle X-ray scattering from synchrotron during the heating of the polymer. Injection of a cool melt into a cold mold yields highly oriented PE rods with a core–shell structure. Samples from both the core and the shell material are studied. The two-dimensional scattering patterns are evaluated utilizing the multi-dimensional chord distribution function (CDF) analysis. From the obvious evolution of the nanostructure during successive crystallite melting, the sequence of processes occurring during crystallization is elucidated. First, nuclei form one-dimensional lattices with short-range order along the fiber axis. From this row structure, lamellae grow with wide lateral extension. An indication of an intermediate block structure is observed. Finally two steps of insertion crystallization result in two long period halvings. Increase of the mold pressure increases the lateral extension of the inserted lamellae in the shell material. In the core material a uniform row structure is absent. Extended primary lamellae form stacks with decreasing long periods before insertion crystallization takes over. But crystallites inserted in the core material do not form extended lamellae. Each of these steps leaves its footprint in the nanostructure and the corresponding scattering pattern. After CDF interpretation of the heating series, the room temperature pattern can be explained. The strong two-point pattern is associated with the primary lamellae and the intensity ridge extending along the meridian results from irregular insertion of lamellae. When the row structure is observed in the CDF, the fiber pattern exhibits equatorial scattering. Domain roughness generates a strong background scattering, which cannot be separated in one step. For the presented material it is shown that iterative background subtraction eliminates the scattering effects of the imperfect (i.e. inserted) lamellae.

OBJECTIVE:To evaluate a prevention program for infant sleep and cry problems and postnatal depression.METHODS:Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes.RESULTS:Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months.CONCLUSIONS:An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.

Poly(ethylene-2,6-naphthalate) (PEN) was crystallized from the glassy state at atmospheric pressure (beyond the end of primary crystallization) and from the melt at high pressure. The structure was characterized using small-angle X-ray scattering (SAXS), wide-angle X-ray scattering (WAXS), differential scanning calorimetry (DSC) and density measurements. The SAXS patterns were analysed using the interface distribution function (IDF) method. For the materials prepared at ambient pressure the crystallinity inside the layer stacks remains nearly constant during the secondary crystallization process. On the other hand, the volume filled with the stacks increases as a function of crystallization temperature (Tc) and time (tc). For Tc > 200°C secondary crystallisation goes along with a dynamic rearrangement of the primary stacks, as concluded from variations of the layer thickness distributions in the SAXS data. For Tc < 200°C primary lamellae are stable, and both insertion of new crystal lamellae into existing stacks and generation of additional stacks is found. In contrast to PET, two different kinds of layer stacks are not observed in the PEN nano-composites. Materials prepared at 400 MPa exhibit high roughness of the crystalline domain surfaces. Depending on Tc there is a continuous transformation from the α to the β-crystal modification, but hardly any change of the long period. Crystal thickness increases, both at the expense of the amorphous thickness and of the volume filled with lamellar stacks. The structure of samples showing two melting peaks is discussed in terms of a dual lamellar contribution of correlated and uncorrelated nano-crystallites, respectively.

The common crystallization conditions of poly(ethylene terephthalate) (PET) were replaced by an anabaric high-pressure crystallization at 320 °C. The PET samples were characterized by differential scanning calorimetry, density and microhardness. The resulting two-phase microstructure was studied by means of absolute small-angle X-ray scattering (SAXS). A complete SAXS analysis utilizing the interface distribution function (IDF) method was carried out. The resulting structure exhibited the presence of stacks of 10 nm thick crystalline lamellae which were separated by amorphous layers of about 1.3 nm thickness. Similar structures have been found after annealing of amorphous metals and have been termed nanocrystalline. Microhardness and structure have been discussed in analogy with the notions from the field of nanostructured materials. Theoretically, a multi-component lamellar two-phase structure has been discussed. The equations derived allow the computation of volume fractions and specific surfaces of the components (different kinds of stacks).

Objective: Mental health problems are an international public health issue affecting a substantial proportion of youth. This study aimed to identify groups of young children exhibiting distinct internalising and externalising symptom trajectories across early childhood compared to existing norms. Linear regression then identified child, parenting and family predictors from infancy in the development of internalising and externalising behaviours at age 5 years. Method: This consisted of a follow-up of 5-year-old children from a longitudinal, population-based study with earlier surveys having been completed by primary caregivers when the children were aged 7, 12, 18, 24 and 36 months. Five hundred 5-year-olds (68% retention) were included from 733 children recruited at age 6–7 months from routine well-child appointments across six socio-economically diverse government areas in Victoria, Australia. Mothers then completed a further questionnaire when their children reached 5 years of age, repeating the instruments included in previous waves. The primary outcomes were the Child Behavior Checklist (CBCL), 1.5–5 internalising and externalising symptoms (T-scores in relation to norms) and behaviours (raw scores). Results: Across early childhood, three distinct profiles for each of the internalising and externalising symptoms (T-scores) were identified and compared to CBCL norms. Around 20% of this Australian child population exhibited consistently elevated symptoms for each problem. Regarding aetiology, longitudinally the strongest predictors of internalising behaviours at 5 years of age were harsh discipline, maternal stress, having no older siblings, single parenthood and maternal substance misuse. The strongest predictors of externalising behaviours at 5 years of age were male sex, harsh discipline and maternal stress. The predictors explained 22% of the variation in internalising behaviours and 24% of the variation in externalising behaviours at 5 years. Conclusions: Starting as early as the toddler period, effective population approaches to preventing mental health problems are needed. Randomised trials of preventive interventions focused on improving parenting practices and reducing maternal stress are under way.

Background Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach. Methods/Design 750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups. Discussion To our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems. Trial registration number ISRCTN: ISRCTN63834603

Investigations of the influence of crystallization conditions and molecular weight on mechanical properties of melt spum monofilaments have been carried out in previous studies [1, 2].

In this paper, we present a method to quickly evaluate the long-term effects of copper-containing metal stack systems for silicon solar cell front–side metallization. Copper diffusion, which is detrimental for the solar cell performance, is accelerated by exposing the cell to thermal stress. In this paper, we suggest to quantify the degree of copper diffusion into the cell by the very fast Suns-VOC technique, measuring the pseudo fill factor pFF. Using three or more different temperatures, and assuming a certain loss in pFF corresponds to a certain depth of diffusion, the effective activation energy for copper diffusion for a given system can be extracted from an Arrhenius plot of the measured data. An extrapolation into temperature regions typical for solar cell modules under outdoor conditions allows an estimation of the fill factor loss for any operation time and temperature. Compared to time- and cost-intensive methods such as transmission electron microscopy or secondary-ion mass spectrometry, this kind of investigation requires only sparse equipment and can typically be done in 1 week per stack system. © 2010 The Electrochemical Society. DOI: 10.1149/1.3466984 All rights reserved.

Objective To determine whether a structured programme of parent anticipatory guidance ‘Toddlers Without Tears,’ delivered in universal primary care, can prevent preschool child behaviour problems. Design Cluster randomised controlled trial. Setting/participants 40 primary care nursing centres (clusters) in metropolitan Melbourne, Australia. 733 English-speaking mothers of 6- to 7-month-old infants consecutively recruited from well-child appointments; 589 (80%) retained at age 3 years. Intervention Parenting programme from age 8 to 15 months, with two group sessions co-led by well-child providers and a parenting expert. The programme addressed normal behaviour development and offered strategies to increase desired and reduce unwanted behaviour. While 93% of intervention parents received at least some of the programme, only 49% completed all components. Control Usual primary care. Main outcome measures Maternal report of child externalising behaviour (Child Behaviour Checklist), parenting (Parent Behaviour Checklist) and maternal mental health (Depression Anxiety Stress Scales) when children were aged 3 years. Results Behaviour scores in the intervention and control groups were similar (mean (SD)) 11.4 (7.1) versus 12.4 (7.6); adjusted mean difference −0.8, 95% CI −2.2 to 0.6, p=0.26). On the parenting subscale scores, intervention parents reported fewer unreasonable expectations of child development (37.3 (10.9) vs 39.9 (10.2), adjusted mean difference −3.1, 95% CI −4.9 to −1.4, p=0.001). The mean scores for harsh/abusive and nurturing parenting, and maternal mental health, were similar between the two groups. Conclusions A brief universal parenting programme in primary care is insufficient to prevent development of preschool externalising problems. A new population trial targeting more intensive prevention to distressed parents with toddler behaviour problems is now under way, aiming to prevent externalising and internalising problems before school entry. Trial registration number ISRCTN77531789

Melt-spinning experiments were carried out at high quenching rates. Mechanical properties (elongation at break, natural draw ratio, and elastic recovery) have been measured. Significant variations of these quantities were observed when extrusion conditions were changed. This has been attributed to different states of the entanglements within the melt, which are directly transferred into the solid state. This intercorrelation between melt and solid-state properties has been substantiated in the case of rapidly cooled samples, where a poor crystallization on one side and a simultaneous good conservation of melt history on the other side are provoked.

We present the results of a LIGO search for short-duration gravitational waves (GWs) associated with Soft Gamma Repeater (SGR) bursts. This is the first search sensitive to neutron star f-modes, usually considered the most efficient GW emitting modes. We find no evidence of GWs associated with any SGR burst in a sample consisting of the 27 Dec. 2004 giant flare from SGR 1806-20 and 190 lesser events from SGR 1806-20 and SGR 1900+14 which occurred during the first year of LIGO's fifth science run. GW strain upper limits and model-dependent GW emission energy upper limits are estimated for individual bursts using a variety of simulated waveforms. The unprecedented sensitivity of the detectors allows us to set the most stringent limits on transient GW amplitudes published to date. We find upper limit estimates on the model-dependent isotropic GW emission energies (at a nominal distance of 10 kpc) between 3x10^45 and 9x10^52 erg depending on waveform type, detector antenna factors and noise characteristics at the time of the burst. These upper limits are within the theoretically predicted range of some SGR models., Comment: 6 pages, 1 Postscript figure

OBJECTIVES. Maternal depression is an established risk for adverse child development. Two thirds of clinically significant depressive symptoms occur in mothers reporting an infant sleep problem. We aimed to determine the long-term effects of a behavioral intervention for infant sleep problems on maternal depression and parenting style, as well as on child mental health and sleep, when the children reached 2 years of age. METHODS. We conducted a cluster-randomized trial in well-child centers across 6 government areas of Melbourne, Australia. Participants included 328 mothers reporting an infant sleep problem at 7 months, drawn from a population sample (N = 739) recruited at 4 months. We compared the usual well-child care (n = 154) versus a brief behavior-modification program designed to improve infant sleep (n = 174) delivered by well-child nurses at ages 8 to 10 months and measured maternal depression symptoms (Edinburgh Postnatal Depression Scale); parenting practices (Parent Behavior Checklist); child mental health (Child Behavior Checklist); and maternal report of a sleep problem (yes or no). RESULTS. At 2 years, mothers in the intervention group were less likely than control mothers to report clinical depression symptoms: 15.4% vs 26.4% (Edinburgh Postnatal Depression Scale community cut point) and 4.2% vs 13.2% (Edinburgh Postnatal Depression Scale clinical cut point). Neither parenting style nor child mental health differed markedly between the intervention and control groups. A total of 27.3% of children in the intervention group versus 32.6% of control children had a sleep problem. CONCLUSIONS. The sleep intervention in infancy resulted in sustained positive effects on maternal depression symptoms and found no evidence of longer-term adverse effects on either mothers' parenting practices or children's mental health. This intervention demonstrated the capacity of a functioning primary care system to deliver effective, universally offered secondary prevention.

We have searched for gravitational waves (GWs) associated with the SGR 1806−20 hyperflare of 27 December 2004. This event, originating from a Galactic neutron star, displayed exceptional energetics. Recent investigations of the x-ray light curve’s pulsating tail revealed the presence of quasiperiodic oscillations (QPOs) in the 30–2000 Hz frequency range, most of which coincides with the bandwidth of the LIGO detectors. These QPOs, with well-characterized frequencies, can plausibly be attributed to seismic modes of the neutron star which could emit GWs. Our search targeted potential quasimonochromatic GWs lasting for tens of seconds and emitted at the QPO frequencies. We have observed no candidate signals above a predetermined threshold, and our lowest upper limit was set by the 92.5 Hz QPO observed in the interval from 150 s to 260 s after the start of the flare. This bound corresponds to a (90% confidence) root-sum-squared amplitude h^(90%)_(rss-det) =4.5×10^(−22) strain Hz^(−1/2) on the GW waveform strength in the detectable polarization state reaching our Hanford (WA) 4 km detector. We illustrate the astrophysical significance of the result via an estimated characteristic energy in GW emission that we would expect to be able to detect. The above result corresponds to 7.7×10^(46) erg (=4.3×10^(−8) M_⊙c^2), which is of the same order as the total (isotropic) energy emitted in the electromagnetic spectrum. This result provides a means to probe the energy reservoir of the source with the best upper limit on the GW waveform strength published and represents the first broadband asteroseismology measurement using a GW detector.

16 pags., 7 figs., Crystallization experiments on amorphous, injection-molded starch in a humid atmosphere are reported. The crystallization mechanisms have been studied using simultaneous SAXS and WAXS during a temperature stepwise increase. In contrast to the crystallization of linear synthetic polymers, in starch the WAXS peaks are observed at low temperature before the appearance of the SAXS maximum. The initial state of crystallization is dominated by the amylose (AM) component of the potato starch alone. After the initial formation of large (16 nm) uncoordinated individual crystallites, stacks of lamellae and finally, an insertion of thinner lamellae within the stacks are observed. Results indicate that only if all AM is converted into a semicrystalline structure and if the secondary starch network of double helices of AM and amylopectin (AP) is molten by a temperature increase above 70°C, crystallization of AP also occurs. Because the AM crystals act as nuclei for the AP component, a common superstructure is developed. Within a spherulite, alternating AM and AP lamellae develop radially from the center of the AP molecule. Results suggest that the AM is distributed inhomogeneously with respect to the AP molecules, leaving approximately one half of the AP fraction free, which means not crystallized to a spherulitic structure together with AM. Copyright © Taylor & Francis Group, LLC., Grateful acknowledgment is due to the MEC, Spain (grant FIS2004-01331) for the generous support of this work. RKB gratefully acknowledges the Secretarıa de Estado de Universidades e Investigacion, MEC, and the ‘‘European Social Fund’’ for the award of a Sabbatical Grant (SAB2003-0131). RKB also thanks the DFG (Deutsche Forschungsgemeinschaft) for the support of this work. The SAXS and WAXS data discussed in this work were derived from measurements carried out at HASYLAB, DESY, Hamburg, under project II-04-029 EC. The IHP-Contract HPRI-CT-1999-00040 of the European Community funded this project. The Arburg Company in Lossburg, Germany is thanked for the kind supply of the injection-molding machine used.

7 pags., 11 figs., A highly crystalline gel (65% crystal portions) was prepared by retrogradation of injection-molded potato starch in humid atmosphere. The different components of the nanostructure were identified by means of successive melting processes using "in situ" simultaneous wide and low angle X-ray diffractions. At low temperatures, structural changes such as annealing phenomena or evaporation of water, giving rise to a thickening of the gel, are observed. In the range of 55-75°C, a first transition due to melting of a layered structure of concentric sphere-like alternating crystalline and amorphous lamellar shells (amylopectine, AP, being the crystalline component) is detected. Analysis of results reveals that the AP crystallization contributes 25% to the overall crystal fraction. A spherulitic structure of alternating radial lamellae from amylose (AM) or AP melts in a higher temperature region between 75 and 86°C. This modification represents the major contribution to crystallinity of about 40%. Unexpectedly, the crystalline blocks of such a structure are abnormally anisometric; i.e., they are thicker than their width. This has been related to a contraction of the AMAP-co-spherulite due to an excessive growth of the AP-shell crystals. The anisometry of the blocks of the AMAP lamellae vanishes at the beginning of the melting of the AP shell crystals, just when the total crystallinity decreases below 50% at 60°C. © 2007 Wiley Periodicals, Inc., One of us (RKB) gratefully acknowledges the Secretarıa deEstado de Universidades e Investigacion, MEC, and the“European Social Fund” for the award of a Sabbatical Grant(SAB2003–0131). RKB also thanks the DFG (Deutsche For-schungsgemeinschaft) for the support of this work. We thank Arburg Company in Lossburg, Germany, for the kind supply of theinjection-molding machine used.

19 pags., 2 figs., The role of melt entanglement network on the structure of amorphous starch, amylose, was investigated. The single helices within the amorphous state showed a disordered conformation. The maximum possible entropy induces an expansion of the molecular coils in the molten state, thereby facilitating an interpretations of the chains leading to the formation of entanglements. It is observed that the mean distance between the entanglements in the molten state is controlled by the chain flexibility. The results show that when the temperature decreases below 70°C, a densification of of the network takes place, which is related to double helix formation through rapproachment of single helices.

During the melting and crystallization of uniaxially oriented polyethylene small-angle X-ray scattering (SAXS) and wide-angle X-ray scattering (WAXS) patterns are recorded simultaneously and continuously, i.e. with high signal-to-noise ratio and a time resolution of 7 s. The multidimensional chord distribution function (CDF) is computed from each of the SAXS patterns and visualises the nanodomain structure of the material in physical space. Thus without application of a model a detailed and continuous multidimensional stream of data is obtained that reveals the mechanisms which govern melting and crystallization in the material studied. Finally the CDF is semi-quantitatively analysed as a function of the temperature programme.

We perform a wide parameter space search for continuous gravitational waves over the whole sky and over a large range of values of the frequency and the first spin-down parameter. Our search method is based on the Hough transform, which is a semi-coherent, computationally efficient, and robust pattern recognition technique. We apply this technique to data from the second science run of the LIGO detectors and our final results are all-sky upper limits on the strength of gravitational waves emitted by unknown isolated spinning neutron stars on a set of narrow frequency bands in the range 200-$400 $Hz. The best upper limit on the gravitational wave strain amplitude that we obtain in this frequency range is $4.43\times 10^{-23}$., Comment: 22 pages, 21 figures, to be submitted to Phys. Rev. D

8 pags., 6 figs., 5 tabs., Microhardness of a series of linear PE samples with a wide range of molecular weights has been determined. The influence of the mode of crystallization from the melt on the mechanical properties has been examined. It is shown that crystal hardness is correlated to the thickness of the amorphous layer for each series of samples. A new expression which describes the microhardness (H) of polyethylene as a function of the average distance between stable entanglements (knots) s is proposed. A value of s = 360 Å, for the mean length between knots in the network is obtained. Analysis of data reveals that the H value can be expressed in terms of the following morphological parameters: 1) average number of chain folds in a lamellar crystal, 2) the nature of the interface between the crystalline and the amorphous layer and 3) the linear crystallinity., Thanks are due to DGICYT (Grant PB94- 0049), Spain, and to NEDO's International Joint Research Program, Japan, for the generous support of this investigation.

2051 Background: Cognitive problems after cancer therapy can decrease QOL. This phase III randomized trial tested the effect of donepezil (5-10 mg daily for 24 weeks) on cognition and QOL in brain cancer patients. Methods: Between 2/2008-12/2011, 198 (99 placebo; 99 donepezil) adult primary and metastatic brain tumor survivors > 6 months post radiation (> 30 Gy) were recruited at 24 sites affiliated with the Wake Forest CCOP Research Base, 3 CTSU sites, and M.D. Anderson. Outcomes were assessed at baseline, 12 and 24 weeks. Regression analyses examined the association of demographics, fatigue (FACIT-Fatigue), and a cognitive performance composite score (CC) (comprised of the Controlled Oral Word Association Test, Hopkins Verbal Learning Test-Revised, Digit Span Test, Trail Making Test A&B, Rey-Osterreith Complex Figure-modified, Grooved Pegboard) on QOL, measured by the FACT-Brain (FACT-Br) total score. Results: Participants had a median age of 55, were predominantly female (54%) and non-Hispanic White (91%), with a median time from diagnosis of 38 months. Study completion was 74%. At 12 and 24 weeks, treatment had no significant effect on QOL, unadjusted and adjusted for race/ethnicity, age, sex, fatigue, baseline FACT-Br, and baseline CC. However, for those below the median on the baseline FACT-Br subscale (i.e., greater cognitive symptoms), donepezil was associated with higher (better) post-tx FACT-Br total scores (p =0.004), unadjusted for covariates. After adjustment for covariates, donepezil was borderline significantly associated with higher post-tx QOL (p=0.052). Improvement in QOL was associated with being female (p=0.017) and less baseline fatigue (p=0.005). For participants with baseline FACT-Br subscale scores above the median, only lower baseline FACT-Br total scores (p=0.015) were significantly related to greater improvements in FACT-Br. Donepezil treatment was not significant (p=0.48). Conclusions: The impact of donepezil on QOL was greater in survivors with more cognitive symptoms at baseline, although the results were borderline significant. Fatigue continued to be a major factor in lower QOL. Other interventions to better manage survivors’ symptoms are needed. Clinical trial information: NCT00369785.

2006 Background: This RCT assessed the effect of 24 weeks of 5-10 mg per day of donepezil, an acetyl cholinesterase inhibitor, on cognitive functioning (primary endpoint) and fatigue, mood and QOL in long-term brain tumor survivors following partial or whole-brain irradiation. Cognitive results are reported herein. Methods: From 2/08-12/11,198 adult primary and metastatic brain tumor survivors > 6 months post radiation treatment (>30 Gray) recruited at 24 sites affiliated with the Wake Forest Community Clinical Oncology Program Research Base, 3 CTSU sites and M.D. Anderson Cancer Center were randomly assigned to receive donepezil (n=99) or placebo (n=99). Cognitive function was assessed at baseline, 12 and 24 weeks with Hopkins Verbal Learning Test-Revised, Rey-Osterreith Complex Figure, Trail Making Test, Digit Span, Controlled Oral Word Association, and Grooved Pegboard. A Cognitive Composite (CC) score was the primary outcome. Results: The sample was 91% White, 54% female, and median age was 55 yrs. 66% had primary tumors, 27% brain metastases and 8% PCI. Median time since diagnosis: 38 mos. 95% had 0-1 ECOG performance status scores. 74% completed the study. CC score improved significantly by 24 weeks in both arms (p < .01); however, there was not a statistically significant difference between groups (p = .57). Donepezil group performed better than placebo on HVLT Recognition (p = .03) and Discrimination (p = .01) and GP-Dominant Hand (p = 0.02). Significant interactions were found between treatment arm and baseline cognitive scores for: CC (p = .01), HVLT Immed. Recall (p = .03), HVLT %Savings (p < .01), Digit Span Forward (p = .01), ROCF Copy (p = .03), TMT-B (p = .05) and GP-Dominant (p < .01). In all cases, the benefit of donepezil, relative to placebo, was greater for those with worse baseline scores. Conclusions: Long-term brain tumor survivors treated with brain irradiation who have cognitive impairment can benefit from 5-10mg of donepezil for 24 weeks. Improvements in verbal memory, working memory, visuo- and psychomotor performance and executive functioning were observed in this group. (Study supported by NIH/NINR grant 5R01NR009675-04, NIH/NCI grant 2 U10 CA 81851-09-13 and Eisai, Inc.) Clinical trial information: NCT00369785.

Natural cements calcined at low temperatures, so-called Roman cements, formed an important binder material in 19th century construction and facade decoration of many European cities and towns. As a rule, Roman cement mortars appear well preserved. In order to understand their range of composition and properties, a number of samples from historic buildings were collected and analyzed. Microscopic techniques including scanning electron microscopy were employed along with the assessment of physico-mechanical properties. The study shows that the most significant feature of Roman cement mortars is a wide range of differently calcined clinker relicts within each mortar. These unreactive particles, classified as being either overfired or underfired, obviously play an important role for the mortar properties. The binder relicts are composed of a number of phases in the system Ca-Si-Al-Fe. C2S and C2AS (gehlenite) are among the most frequent compounds, their grain size and microstructure depending on calcination temperatures. In particular, the clinkers produced at lower temperatures show nonequilibrium features such as solid solution systems and zoning by partial diffusion. The aggregates found in the mortars cover a wide range of mineralogical compositions reflecting local geological conditions. Cast and in situ applied mortars differ in the amount of aggregate, which is generally lower for cast elements. There is no correlation between the amount of inert material and the state of preservation indicated, e.g., by the occurrence of shrinkage cracks. Historic cast mortars show high compressive strengths at comparably low moduli of elasticity. The total porosity is frequently high. This contribution presents the above-mentioned properties and discusses them in terms of the excellent aging performance of the historic Roman cement mortars.

In the first part of this series, the influence of mold geometry was examined with reference to the improvement of the mechanical properties of elongational flow injection-molded polyethylene. In the present study (Part 2), processing parameters have been investigated and the physical properties of the moldings examined. It is confirmed that mainly two parameters, the temperature of the melt and the pressure on the solidifying mold, govern the injection process. Results are discussed in terms of the molecular orientation that is developed during the filling process and depends on the temperature of the melt. The application of high pressures leads to a pressure-induced crystallization effect that freezes in the molecular orientation within the mold.

Background The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful 'efficacy' trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry. Methods/Design This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child's bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (cost-consequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms. Discussion This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally. Trial Registration ISRCTN: ISRCTN30996662 RCH Human Research Ethics Approval 30105A