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The brain has an incredible capacity to learn how to control various effectors, ranging from those endogenous the body to those that are artificially implanted. Moreover, changes to these effectors can be readily adapted by the brain, albeit on varying timescales depending on the amount of perturbation. For example, many studies have shown adaptation to force perturbations or visual-motor rotations to occur within minutes, attributing the adaptation to inputs from the cerebellum. This flexible adaptation of the brain makes the use of brain-machine interfaces (BMIs) an attractive rehabilitative option for a variety of motor pathologies such as stroke and amyotrophic lateral sclerosis. BMIs allow users to interact with their environments by using signals recorded directly from the brain and transforming them into actions taken on by an external effector such as a computer cursor or robotic arm. Past work has shown neurons to adapt to decoders over time, suggesting BMIs as an exciting paradigm for neural rehabilitation. Modern decoding methods involve using closed-loop decoder adaptation (CLDA) allowing for decoder weights to converge quickly, and users to gain high levels of control with very little training. Furthermore, these weights can be updated over learning in the event there are changes in the neural population. While great for assistive devices, it is unclear how these decoders impact neural adaptation over time. To answer this question, we conducted four studies examining the interplay between decoder adaptation and changes in neural activity over learning. Previous studies in the field have shown neural activity to fire in increasingly correlated patterns, converging onto low-dimensional spaces as performance with a BMI improves, indicating consolidation of coordinated firing patterns. However, these studies were conducted with static decoders. To examine how neurons adapt alongside CLDA, we used nonhuman primate models to observe how neurons in motor cortex adapt when decoder weights change in a BMI task. We found that there is a concomitant exploration-exploitation strategy that occurs where changes in decoder weights yield increases in exploratory neural activity, which in turn consolidates over many days. These results are remarkably paralleled by those in the psychophysics literature, suggesting similar mechanisms of adaptation between the two regimes. Furthermore, we found that initial levels of decoder adaptation bear no impact on the rate of neural adaptation. That is, decoders resulting in better initial performance of a BMI did not affect how quickly neurons adapted over multiple days.However, we found that there are differences in adaptation between neurons used as decoder inputs compared to other neurons in the local supporting network. While neurons that were delegated as decoder inputs explored and eventually collapse onto a low-dimensional space, neurons in the supporting local network had comparatively less exploration and consolidation of activity. Strikingly though, these support neurons show task-relevant behavior throughout learning. In combination, these results suggest that neural adaptation to BMIs is driven by network solutions that aim to improve performance through exploring new patterns rather than suppressing preexisting ones. Rather than improving control of the BMI by decreasing noise, motor cortex seems to boost the signal quality instead. Together, the results in this body of work highlight mechanisms of neural adaptation to neuroprosthetic devices that mirror those of natural motor adaptation. Exploiting these mechanisms may lead to better methods of utilizing BMIs for neural rehabilitation.

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents’ mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents’ mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

Schools often provide structure and safety to students but particularly for vulnerable children and young people. The Covid 19 pandemic has caused unprecedented upheaval across society as a whole but it is clear that the effects are uneven and that some groups have been more directly and negatively impacted, both in the UK and globally. While there are now much helpful quantitative data on the effects of Covid 19 on education, there has been little in-depth qualitative study which examines the experiences and attitudes of young people as students and specifically the effect of school closures and exam cancellations on their mental health and wellbeing. This paper discusses findings from online group interviews with a total of 45 young people and aims to understand the impact on mental health and wellbeing and what young people, themselves, suggest would help mitigate the effects of the global pandemic on their mental health and wellbeing in school.

We report the excited-state behavior of a structurally simple bis-sulfoxide complex, cis-S,S-[Ru(bpy)2(dmso)2]2+, as investigated by femtosecond pump–probe spectroscopy. The results reveal that a single photon prompts phototriggered isomerization of one or both dmso ligands to yield a mixture of cis-S,O-[Ru(bpy)2(dmso)2]2+ and cis-O,O-[Ru(bpy)2(dmso)2]2+. The quantum yields of isomerization of each product and relative product distribution are dependent upon the excitation wavelength, with longer wavelengths favoring the double isomerization product, cis-O,O-[Ru(bpy)2(dmso)2]2+. Transient absorption measurements on cis-O,O-[Ru(bpy)2(dmso)2]2+ do not reveal an excited-state isomerization pathway to produce either the S,O or S,S isomers. Femtosecond pulse shaping experiments reveal no change in the product distribution. Pump–repump–probe transient absorption spectroscopy of cis-S,S-[Ru(bpy)2(dmso)2]2+ shows that a pump–repump time delay of 3 ps dramatically alters the S,O : O,O product ratio; pump–repump–probe transient absorption spectroscopy of cis-O,O-[Ru(bpy)2(dmso)2]2+ with a time delay of 3 ps uncovers an excited-state isomerization pathway to produce the S,O isomer. In conjunction with low-temperature steady-state emission spectroscopy, these results are interpreted in the context of an excited-state bifurcating pathway, in which the isomerization product distribution is determined not by thermodynamics, but rather as a dynamics driven reaction., We report the excited-state behavior of a simple bis-sulfoxide complex, cis-S,S-[Ru(bpy)2(dmso)2]2+, as investigated by femtosecond pump–probe spectroscopy.

Funding Health Data Research UK (grant reference number MR/S003800/1). Acknowledgements The study was sponsored by Health Data Research UK (www.hdruk.ac.uk), which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome (grant reference number MR/S003800/1). The sponsor and funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication. This study formed part of a wider PhD thesis undertaken by the lead author within the University of Glasgow and was published in 2017. Certain sections of this paper appear in the thesis, which is accessible and downloadable from the following link: http://theses.gla.ac.uk/8594/1/2017flemingphd.pdf. Author Contributions J.P.P. had the original concept. All authors agreed the study design. D.C. and A.K. provided data and undertook record linkage. M.F. and D.F.M. undertook the statistical analyses. All authors interpreted the results. M.F. and J.P.P. drafted the manuscript and all other authors contributed revisions. All authors reviewed and approved the final version of the manuscript. M.F. is guarantor for the study. Approvals The authors applied for permission to access, link and analyse these data and undertook mandatory training in data protection, IT security and information governance. Therefore, the datasets generated and analysed during the study are not publicly available. The study was approved by the National Health Service Privacy Advisory Committee and covered by a data-processing agreement between Glasgow University and ISD, and a data-sharing agreement between Glasgow University and ScotXed. All data were linked by the Electronic Data Research and Innovation Service (eDRIS), part of NHS National Services Scotland. Ethics The NHS West of Scotland Research Ethics Service confirmed that formal NHS ethics approval was not required, since the study involved anonymized extracts of routinely collected data with an acceptably negligible risk of identification. Conflict of interest: None declared

Background: \ud Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers.\ud \ud Methods: \ud Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions.\ud \ud Results: \ud Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes.\ud \ud Conclusions: \ud Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.

Background Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Methods and findings Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. Conclusions Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system., In this record-linkage study in Scotland, Michael Fleming and colleagues compare educational and health outcomes for children who are in the care of their local authority with the outcomes of their peers., Author summary Why was this study done? Looked after children, defined as children placed in the care of their local authority, comprise a vulnerable cohort exhibiting poorer educational and health outcomes compared to peers. Only a few small sample studies have been conducted in the UK, and a recent systematic review reported an urgent need for more population-wide research into the educational outcomes of children placed in social care services. To our knowledge, no previous UK studies have dually investigated educational and health outcomes of looked after children compared to peers using an unselected, nationwide cohort. What did the researchers do and find? We linked together 9 Scotland-wide databases to compare educational and health outcomes of looked after children against peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Looked after children had increased risk of school absenteeism and exclusion; special educational need (SEN); poor academic attainment; unemployment; hospitalisation and mortality; and treatment for epilepsy, attention deficit hyperactivity disorder (ADHD), depression, and neurodevelopmental multimorbidity. Among children in care, those looked after away from home had less absenteeism, less exclusion, less unemployment, and better attainment. What do these findings mean? Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

Background To compare health, educational and employment outcomes of schoolchildren receiving medication for a skin disorder with peers. Methods This retrospective population cohort study linked eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, school examinations, school absences/exclusions and unemployment to investigate educational (absence, exclusion, special educational need, academic attainment), employment, and health (admissions and mortality) outcomes of 766,244 children attending local authority run primary, secondary and special schools in Scotland between 2009 and 2013. Results After adjusting for sociodemographic and maternity confounders the 130,087 (17.0%) children treated for a skin disorder had increased hospitalisation, particularly within one year of commencing treatment (IRR 1.38, 95% CI 1.35–1.41, p Conclusions Despite increased hospitalisation, school absenteeism, and special educational need, children treated for a skin disorder did not have poorer exam attainment or employment outcomes. Whilst findings relating to educational and employment outcomes are reassuring, the association with increased risk of mortality is alarming and merits further investigation.

Background Neurodevelopmental conditions commonly co-exist in children but, in comparison with adults, childhood multimorbidity has attracted less attention in research and clinical practice. Methods Record linkage of five Scotland-wide databases produced a cohort of 766,244 children attending Scottish schools between 2009 and 2013. Autistic spectrum disorder (ASD) and intellectual disabilities were ascertained from records of special educational need in the annual Pupil Census and attention deficit hyperactivity disorder (ADHD) and depression through relevant encashed prescriptions. Results Neurodevelopmental multimorbidity (≥2 conditions) was identified in 4,789 (0·6%) children; with ASD and ADHD the most common combination. Multimorbidity was associated with significantly increased risk of school absenteeism (adjusted IRR 1·23, 95% CI 1·20-1·28), school exclusion (adjusted IRR 3·04, 95% CI 2·74-3·38), low attainment (adjusted OR 12·07, 95% CI 9·15-15·94) and unemployment (adjusted OR 2·11, 95% CI 1·83-2·45) with clear dose relationships evident between number of conditions (0, 1, ≥2) and the last three outcomes. The associations with multimorbidity were stronger in girls than boys. Co-existence of depression was the strongest driver of absenteeism and co-existence of ADHD the strongest driver of exclusion. Low attainment and unemployment were, in part, mediated by absence and attainment respectively, and were not driven by specific conditions but rather multimorbidity from any cause. Conclusions Structuring clinical practice and training around single conditions may disadvantage children with multimorbidity who are at significantly increased risk of adverse outcomes if their complex needs are not recognised and managed. Key messages Neurodevelopmental multimorbidity can have significant impacts on children’s education. A holistic healthcare approach is needed to reduce the address their needs and reduce the risk of adverse outcomes.

OBJECTIVE This study was conducted to determine the association between childhood type 1 diabetes and educational and health outcomes. RESEARCH DESIGN AND METHODS Record linkage of nine Scotland-wide databases (diabetes register, dispensed prescriptions, maternity records, hospital admissions, death certificates, annual pupil census, school absences/exclusions, school examinations, and unemployment) produced a cohort of 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. We compared the health and education outcomes of schoolchildren receiving insulin with their peers, adjusting for potential confounders. RESULTS The 3,330 children (0.47%) treated for type 1 diabetes were more likely to be admitted to the hospital (adjusted hazard ratio [HR] 3.97, 95% CI 3.79–4.16), die (adjusted HR 3.84, 95% CI 1.98–7.43), be absent from school (adjusted incidence rate ratio [IRR] 1.34, 95% CI 1.30–1.39), and have learning difficulties (adjusted odds ratio [OR] 1.19, 95% CI 1.03–1.38). Among children with type 1 diabetes, higher mean HbA1c (particularly HbA1c in the highest quintile) was associated with greater absenteeism (adjusted IRR 1.75, 95% CI 1.56–1.96), increased school exclusion (adjusted IRR 2.82, 95% CI 1.14–6.98), poorer attainment (adjusted OR 3.52, 95% CI 1.72–7.18), and higher risk of unemployment (adjusted OR 2.01, 95% CI 1.05–3.85). CONCLUSIONS Children with type 1 diabetes fare worse than their peers in respect of education and health outcomes, especially if they have higher mean HbA1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment.

Learning disability varies by month of conception. The underlying mechanism is unknown but vitamin D, necessary for normal brain development, is commonly deficient over winter in high latitude countries due to insufficient ultraviolet radiation. We linked the 2007–2016 Scottish School Pupil Censuses to Scottish maternity records and to sunshine hours and antenatal ultraviolet A/B radiation exposure derived from weather stations and satellites respectively. Logistic regression analyses were used to explore the associations between solar radiation, then ultraviolet B, and learning disabilities, adjusting for the potential confounding effects of month of conception and sex. Of the 422,512 eligible, singleton schoolchildren born at term in Scotland, 79,616 (18.8%) had a learning disability. Total antenatal sunshine hours (highest quintile; adjusted OR 0.89; 95% CI: 0.86, 0.93; p

Laban Movement Analysis (LMA) is a movement notation system widely used among dancers and choreographers, actors, body-oriented psychotherapists, and more recently in user- experience design. Like music, movement can be observed and notated. The experience of the mover and those observing is a relationship with the environment that can be recorded on a deeper level than reported feedback, an embodied experience (Bartenieff & Lewis, 1980). What is a user or user group’s body language? How can designers use this information to better develop spaces that facilitate user needs? This special session workshop proposes using LMA as a tool to observe and record movement in order to analyze the meaning of an experience within a space or with a product.

BackgroundThere is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population.MethodsPopulation data linkage study utilising national datasets of social work referrals for ‘looked after’ placements, the Scottish census of children in local authority schools, and national health service’s dental health and service datasets.Results633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04).ConclusionsLAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system.

Background: Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes. Methods: We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011. Results: Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (≤3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (CI) 4.44–8.54, p

Background and objectives: \ud \ud Children in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population-based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population-based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.\ud \ud Study design and methods: \ud \ud National demonstration project testing the feasibility of linking routinely collected looked after children, education and health data.\ud \ud Participants: \ud \ud All children in publicly funded school in Scotland in 2011/12.\ud \ud Results: \ud \ud Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the National Health Service Scotland master patient index demonstrated that a safe link to the child's unique health service (Community Health Index) number could be obtained for a very high proportion of children in each group (94%, 95% and 95% of children classified as currently, previously, and non-looked after, respectively). In general, linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.\ud \ud Conclusions: \ud \ud This novel data linkage demonstrates the feasibility of monitoring population-based health outcomes of school-aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are preschool or postschool, home schooled or in independent schooling).

Importance Attention-deficit/hyperactivity disorder (ADHD) affects 39 million people worldwide; in isolation, it doubles annual health care costs and, when associated with comorbid mental health problems, it quadruples the costs. Objective To compare the education and health outcomes of schoolchildren treated for ADHD with their peers. Design, Setting, and Participants In this population-based cohort study, individual-level record linkage was performed of 8 Scotland-wide administrative databases covering dispensed prescriptions, admissions to acute and psychiatric hospitals, maternity records, annual pupil census, examinations, school absences and exclusions, and unemployment. The study cohort comprised 766 244 children attending Scottish primary, secondary, and special schools at any point between September 21, 2009, and September 18, 2013. Data analysis was performed from June 1, 2015, to December 6, 2016. Exposures Medication approved solely for ADHD treatment. Main Outcomes and Measures Special educational needs, academic attainment, unauthorized absence, exclusion, age at leaving school, unemployment after leaving, and hospitalization. Outcomes were adjusted for potential sociodemographic, maternity, and comorbidity confounders. Results Of the 766 244 schoolchildren, 7413 (1.0%) were treated for ADHD; 6287 (84.8%) were male. These children had higher rates of unauthorized absence (adjusted incidence rate ratio [IRR], 1.16; 95% CI, 1.14-1.19) and exclusion (adjusted IRR, 5.79; 95% CI, 5.45-6.16), more commonly had a record of special educational need (adjusted odds ratio [OR], 8.62; 95% CI, 8.26-9.00), achieved lower academic attainment (adjusted OR, 3.35; 95% CI, 3.00-3.75), were more likely to leave school before age 16 years (1546 [64.3%] vs 61 235 [28.4%]), and were more likely to be unemployed (adjusted OR, 1.39; 95% CI, 1.25-1.53). Children with ADHD were more likely to require hospitalization overall (adjusted hazard ratio [HR], 1.25; 95% CI, 1.19-1.31) and for injury (adjusted HR, 1.52; 95% CI, 1.40-1.65). Conclusions and Relevance Even while receiving medication, children with ADHD fare worse than their peers across a wide range of outcomes relating not only to education but also to health.

ObjectivesChildren that are ‘looked after’ include those that are accommodated in foster, kinship and residential care placements, as well as those at home on compulsory supervision. They have poorer physical and mental health than their peers and there are concerns about the relatively high levels of untreated morbidity. Oral health and access to dental services among Looked After Children (LAC) has received limited attention to date. The objective of this study was to compare the oral health and access to dental services of children who are looked after by the state, with comparable children in the general population. ApproachSchool and Social Work datasets were able to be linked using the Scottish Exchange of Data (ScotXed) Unit. This in turn was linked with health data making use of the Scottish national record-linkage system provided by the NHS eDRIS team for the FARR Institute Scotland. All of the following datasets used in this study are complete national datasets for the time periods noted. School Pupil Census 2012: a census of children in local authority primary and secondary schools that provides each child’s age, sex and socioeconomic status as measured by the Scottish Index of Multiple Deprivation (SIMD). The other datasets cover the period 2008-2012: LAC- all children with social work referrals for various types of placement; registration with dentists; hospital discharge data for all episodes of tooth extraction; National Dental Inspection Programme (NDIP) data from Primary 1 and Primary 7 school years (dental decay). The LAC group were compared to their peers by logistic regression adjusted by SIMD, using remote access to the National Safe Haven. ResultsThere were 633204 subjects in the study group (10927 LAC, 622280 nonLAC). Ages ranged from four to 17 years (mean 12 LAC and 10 nonLAC); with 53% male for LAC and 51% nonLAC; and 42% in the most deprived SIMD level for LAC and 21% for non-LAC. The subjects in the LAC group were more likely to have dental decay at Primary 1, odds-ratio (OR) 2.93 (2.55, 3.38), and Primary 7, OR 1.81 (1.68, 1.94). LAC subjects were less likely to be registered with a dentist, OR 0.50 (0.43, 0.59), and more likely to have teeth extracted, OR 1.50 (1.40, 1.60). All tests p

Background Chronic ill health can affect children's educational and health outcomes. Previous studies have reported poorer school outcomes among children with diabetes, asthma, epilepsy, attention deficit hyperactivity disorder (ADHD), and depression; however, many have limitations, very few have analysed multiple outcomes or population-wide data, and literature in Scotland and the UK is scarce. We aimed to identify children prescribed medication for these chronic medical conditions and investigate their educational and health outcomes compared with their peers. Methods We retrospectively linked Scotland-wide education records for children attending primary and secondary schools in Scotland between 2009 and 2013 to prescribing data, acute and psychiatric hospital admissions, maternity records, and deaths. School absenteeism, exclusion, and special educational need were analysed annually using generalised estimating equations. Academic attainment was analysed using generalised ordinal logistic regression and unemployment with binomial logistic regression. All-cause hospitalisation and mortality were analysed using Cox proportional hazards or Poisson piecewise regression. Analyses were restricted to singleton children born in Scotland and adjusted for sociodemographic or maternity factors and comorbid conditions Findings 766 244 schoolchildren were included in the analyses. All conditions were associated with increased school absenteeism (diabetes incidence rate ratio [IRR] 1·34, asthma 1·25, epilepsy 1·50, ADHD 1·18, depression 1·95), special educational need (diabetes odds ratio [OR] 2·45, asthma 1·28, epilepsy 10·11, ADHD 8·77, depression 2·24], and all-cause hospitalisation (diabetes hazard ratio [HR] 3·97, asthma 1·69, epilepsy 3·72, ADHD 1·33, depression 2·56). All, excluding diabetes, were associated with poorer academic attainment (asthma OR 1·11, epilepsy 4·07, ADHD 3·64, depression 3·44] and all, excluding ADHD, were associated with increased all-cause mortality [diabetes HR 3·84, asthma 1·77, epilepsy 24·77, depression 6·21]. ADHD (IRR 5·82) and depression (1·65) were associated with increased exclusion from school, whereas epilepsy (OR 1·99), ADHD (1.42), and depression (1·98) were associated with subsequent unemployment. Interpretation In addition to poorer health outcomes, schoolchildren with these chronic medical conditions have significant educational disadvantage compared with their peers. Interventions and further understanding of the relationships between health and education among children with these conditions is required. Funding Health Data Research UK

Background The global prevalence of childhood asthma is increasing. The condition impacts physical and psychosocial morbidity; therefore, wide-ranging effects on health and education outcomes are plausible. Methods Linkage of eight Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions and unemployment, provided data on 683 716 children attending Scottish schools between 2009 and 2013. We compared schoolchildren on medication for asthma with peers, adjusting for sociodemographic, maternity and comorbidity confounders, and explored effect modifiers and mediators. Results The 45 900 (6.0%) children treated for asthma had an increased risk of hospitalisation, particularly within the first year of treatment (incidence rate ratio 1.98, 95% CI 1.93–2.04), and increased mortality (HR 1.77, 95% CI 1.30–2.40). They were more likely to have special educational need for mental (OR 1.76, 95% CI 1.49–2.08) and physical (OR 2.76, 95% CI 2.57–2.95) health reasons, and performed worse in school exams (OR 1.11, 95% CI 1.06–1.16). Higher absenteeism (incidence rate ratio 1.25, 95% CI 1.24–1.26) partially explained their poorer attainment. Conclusions Children with treated asthma have poorer education and health outcomes than their peers. Educational interventions that mitigate the adverse effects of absenteeism should be considered., Asthmatic children experience significant disadvantage in addition to poor health. Adverse effects on other aspects of their life, such as education, need to be recognised and addressed. bit.ly/2W5K4Nib

Learning disabilities have profound, long-lasting health sequelae. Affected children born over the course of 1 year in the United States of America generated an estimated lifetime cost of $51.2 billion. Results from some studies have suggested that autistic spectrum disorder may vary by season of birth, but there have been few studies in which investigators examined whether this is also true of other causes of learning disabilities. We undertook Scotland-wide record linkage of education (annual pupil census) and maternity (Scottish Morbidity Record 02) databases for 801,592 singleton children attending Scottish schools in 2006-2011. We modeled monthly rates using principal sine and cosine transformations of the month number and demonstrated cyclicity in the percentage of children with special educational needs. Rates were highest among children conceived in the first quarter of the year (January-March) and lowest among those conceived in the third (July-September) (8.9% vs 7.6%; P

Background Analysis of routine data provides an efficient way of exploring health risks and outcomes. We aimed to undertake the first Scotland-wide linkage of children's health and education data to show the feasibility of such cross-sectoral linkage for research. Methods We undertook a data linkage study of children in Scottish schools between 2006–07 and 2011–12. The main datasets were the annual Scottish Government pupil census, which contains Scottish candidate numbers (SCNs; unique identifier used on education records) and personal identifiers for children in publicly funded schools; and the Community Health Index (CHI) database held by NHS National Services Scotland (NSS), which contains CHI numbers (unique identifier used on health records) and identifiers for patients registered with a GP. Restricted pupil identifiers available for linkage in the pupil census (date of birth, sex, home postcode) were matched against patient identifiers held on the CHI database by a bespoke version of NSS's in-house medical record linkage software (previously validated). A best match CHI and additional possible (rival) CHIs were identified for each pupil and assigned probabilistic scores suggesting the amount of agreement between identifiers. Links were then partitioned into categories depending on scores. Links within specified categories (best match CHI with exact agreement on all identifiers or with postcode differing by one character only, and nearest rival CHI with lower score) were regarded as secure, and best match CHIs were accepted. Two methods of linkage were explored: linking identifiers from each year's pupil census separately (A) and combining all the available pupil identifier data from each census into one record per pupil and then linking the combined records (B). Two quality checks were undertaken to assess whether accepted CHIs were correct. Pupil names are available in pupil census records, but the government is unable to share these for linkage purposes. NSS therefore returned SCNs and full names from the best matching CHI records to the government. The government then used name-matching algorithms to compare these with the names in the pupil census. The Scottish Qualifications Agency provided SCNs and full pupil identifiers (including names) for the subset of children registered for Scottish examinations. NSS ran these data through their established probabilistic matching algorithms and the CHI numbers obtained were compared with those from the pupil census linkage. The SCN–CHI key resulting from the linkage was used to construct an anonymised analysis dataset including children's delivery records and their educational attendance, needs, and attainment records. This dataset was used to explore educational outcomes for children with different birth presentations and delivery modes to assess its utility in answering research questions. The results are reported elsewhere. Findings Using linkage method A, an acceptable CHI number could be found for 607 115 (86·3%) of 703 500 children in the 2006–07 census, increasing to 623 396 (92·9%) of 671 264 in 2011–12. Comparable figures using method B were 655 429 of 703 500 (93·2%) in 2006–07 and 638 011 of 671 264 (95·0%) in 2011–12. Linkage method B was therefore regarded as preferable. Using linkage method B, both quality checks suggested that over 99% of the accepted CHIs were indeed correct for children in the 2006–07 and 2011–12 censuses. Interpretation Routine health and education data in Scotland can be linked to an acceptable quality for public health research purposes, despite the absence of names available for linkage within education datasets. This finding opens up the potential for a range of policy-relevant life-course research drawing on routine data from different sectors. Funding Scottish Collaboration for Public Health Research and Policy (https://www.scphrp.ac.uk/node/264).

Antecedents of achievement motivation of young children were examined in a two-phase study. Phase 1 studied the achievement motivation of preschoolers and their parents. Children's achievement motivation was measured by the Animal Crackers test and by teachers' ratings using the Children's Achievement Rating Scale (CARS). Parent measures were their social position and the Achievement Checklist. Results indicated that children's achievement motivation was related to teacher's ratings of achievement and parents' social position, and that daughter's achievement was related to father's achievement. Phase 2 related achievement motivation, as measured by five factors of CARS (Task Orientation, Verbal Orientation, Nongoal Orientation. Involvement/Enthusiasm, and Teacher Orientation), to children's (N = 176) control over event outcomes with others and themselves on the Stephens-Delys Reinforcement Contingency Interview, Children's task and verbal orientation was related to control over peers and teachers...

To investigate relationships among social-nonsocial and positive/negative locus of control, the Stephens-Delys Reinforcement Contingency Interview (SDRCI) and the Stanford Preschool Internality-Externality Scale (SPIES) were administered to 111 preschoolers. Children perceived more control over positive and social outcomes than over negative and nonsocial outcomes on both scales. No correlations were observed between social and nonsocial locus of control. Positive and negative locus of control were highly correlated on the SDRCI but not on the SPIES; however, positive/social and negative/nonsocial items were confounded on the SPIES. Results were interpreted as supporting independence of social/nonsocial locus of control but not of positive/negative locus of control for preschool children.

The purpose was to investigate the development of preschoolers' locus of control (LOC) in relation to social agents, parental LOC, achievement motivation, and LOC dimensions. Children (N = 65) responded to the Stephens-Delys Reinforcement Contingency Interview; teachers rated children on achievement-related behavior while parents completed the Adult Nowicki-Strickland Internal-External Scale. Children's perceptions of control over all social agents except themselves were highly correlated. Children perceived the most control over social interactions involving teachers, mothers and fathers, and significantly less control over peers and themselves. No correlations were found between children's and parent's LOC nor between children's LOC and teachers' ratings of achievement. Results suggest that LOC may not be acquired through modeling but rather through contingent reinforcement. Since achievement ratings primarily reflected the child's interactions with object-related tasks and since LOC measures i...

Summary The focus of the study was to examine the relationship between communication skills and popularity of preschool children (N = 60) in mixed-age (3 years 2 months to 6 years 6 months) classrooms. Communication skills were measured by assessing children's describing and listening skills utilizing a modified Dickson's Notebook Communication Game. Classroom teachers rank ordered the children in their classrooms from most to least popular. PPVT was utilized to measure children's vocabulary level. Partial correlations controlling for classroom membership resulted in ranked popularity correlating with listening skills but not with ability to describe or with sex of the children; teachers perceived older children to be more popular than younger children. Partial correlations between popularity and each variable controlling for all other variables yielded one significant relationship with age. Implications for mixed-age preschool groups are discussed.

Summary To investigate the differences in sex-role related behavioral preferences, three questionnaires were administered to females majoring in engineering (n = 95) and social sciences (n = 188): Work Interest Questionnaire, Opinions About Children, and Bem's Sex Role Inventory. Findings indicated that engineering students scored significantly higher on work incentives, promotion, and incisive and diplomatic actions while social science students scored higher on femininity, family-related, and work-flexibility factors. Engineering students indicated significantly higher need for having children and being good mothers but preferred smaller families than the social science students. A significantly higher percentage of engineering students were first-borns and came from larger cities than the social science students.