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Soldier deployment can create a stressful environment for U.S. Army families with young children. Prior research has identified elevated rates of child maltreatment in the 6 months immediately following a soldier's return home from deployment. In this study, we longitudinally examine how other child- and family-level characteristics influence the relationship of deployment to risk for maltreatment of dependent children of U.S. Army soldiers.We conducted a person-time analysis of substantiated reports and medical diagnoses of maltreatment among the 73,404 children of 56,087 U.S. Army soldiers with a single deployment between 2001 and 2007. Cox proportional hazard models estimated hazard rates of maltreatment across deployment periods and simultaneously considered main effects for other child- and family-level characteristics across periods.In adjusted models, maltreatment hazard was highest in the 6 months following deployment (hazard ratio [HR] = 1.63, p0.001). Children born prematurely or with early special needs independently had an increased risk for maltreatment across all periods (HR = 2.02, p0.001), as well as those children whose soldier-parent had been previously diagnosed with a mental illness (HR = 1.68, p0.001). In models testing for effect modification, during the 6 months before deployment, children of female soldiers (HR = 2.22, p = 0.006) as well as children of soldiers with a mental health diagnosis (HR = 2.78, p = 0.001) were more likely to experience maltreatment, exceeding the risk at all other periods.Infants and children are at increased risk for maltreatment in the 6 months following a parent's deployment, even after accounting for other known family- and child-level risk factors. However, the risk does not appear to be the same for all soldiers and their families in relation to deployment, particularly for female soldiers and those who had previously diagnosed mental health issues, for whom the risk appears most elevated before deployment. Accounting for the unique needs of high-risk families at different stages of a soldier's deployment cycle may allow the U.S. Army to better direct resources that prevent and address child maltreatment.

In cases of maltreatment involving children of U.S. Army service members, the U.S. Army Family Advocacy Program (FAP) is responsible for providing services to families and ensuring child safety. The percentage of cases of maltreatment that are known to FAP, however, is uncertain. Thus, the objective of this retrospective study was to estimate the percentage of U.S. Army dependent children with child maltreatment as diagnosed by a military or civilian medical provider who had a substantiated report with FAP from 2004 to 2007. Medical claims data were used to identify 0–17 year old child dependents of soldiers who received a medical diagnosis of child maltreatment. Linkage rates of maltreatment medical diagnoses with corresponding substantiated FAP reports were calculated. Bivariate and multivariable analyses examined the association of child, maltreatment episode, and soldier characteristics with linkage to substantiated FAP reports. Across 5945 medically diagnosed maltreatment episodes, 20.3% had a substantiated FAP report. Adjusting for covariates, the predicted probability of linkage to a substantiated FAP report was higher for physical abuse than for sexual abuse, 25.8%, 95% CI (23.4, 28.3) versus 14.5%, 95% CI (11.2, 17.9). Episodes in which early care was provided at civilian treatment facilities were less likely to have a FAP report than those treated at military facilities, 9.8%, 95% CI (7.3, 12.2) versus 23.6%, 95% CI (20.8, 26.4). The observed low rates of linkage of medically diagnosed child maltreatment to substantiated FAP reports may signal the need for further regulation of FAP reporting requirements, particularly for children treated at civilian facilities.

Background Achilles tendinopathy is a common overuse injury in running and jumping athletes. Currently, we do not understand why some conservative interventions (eg, noxious electrical stimulation and eccentric training) may reduce the pain associated with tendinopathy. Objective To determine whether noxious electrical stimulation (NES) or eccentric contractions would alter pain sensitivity around the asymptomatic Achilles tendon. Design A double-blind trial with block-randomization by gender into 3 intervention arms: NES, eccentric contractions, or low-intensity cycling. Participants A total of 40 volunteers with no current pain conditions started the study, and 39 completed follow-up testing. Methods Participants underwent 2 baseline sessions to assess pain sensitivity response stability of pressure pain threshold (PPT), heat pain threshold (HPT), and heat temporal summation (HTS) over the Achilles tendon. Immediately after the second baseline session, participants performed 1 session of an intervention and were tested immediately postintervention and the next morning. Eccentric-only plantarflexor exercise was performed (4 sets of 15 repetitions) using full bodyweight and slow, 5-second contractions. Noxious electrical stimulation was applied to the Achilles for 20 minutes and dosed to the subjects' pain tolerance. Low-intensity cycling was dosed (60-70 W for 20 minutes) to minimize occurrence of exercise-induced hypoalgesia. The PPT was the primary outcome measure. Results For PPT, both NES ( P P = .003) groups were less sensitive to pressure immediately posttreatment, and the eccentric group maintained this effect through the next morning ( P = .043). No group differences were seen for HPT, but the NES ( P = .031) and eccentric ( P = .036) groups had less HTS the next morning. Conclusions A single session of eccentric exercise and NES can produce immediate and next-day reductions in pain sensitivity in asymptomatic adults. The immediacy of these effects points toward a neurophysiologic mechanism. Future research needs to be performed in clinical populations and to assess any cumulative effects to repetitive intervention.

A 210Pb-dated sediment core from a small bay in the southern basin of Lake Peten Itza, Guatemala documents recent cultural eutrophication. Increased sediment accumulation beginning ∼1930 A.D. coincided with catchment population growth and was a consequence of watershed deforestation and increased surface run-off. At the same time, geochemical records from the Lake Peten Itza sediment core indicate increased phosphorus loading and organic matter accumulation. High nutrient concentrations after 1965 A.D. coincided with lower sediment C/N ratios, suggesting an increase in the relative contribution of phytoplankton to the organic matter pool. This inference is confirmed by the dominance of eutrophic and hypereutrophic diatom species. Organic matter δ13C values decreased after 1965 A.D., seemingly contradicting other indicators of recent eutrophication in the southern basin of Lake Peten Itza. Relatively depleted δ13C values in recent sediments, however, may reflect a contribution from 13C-depleted sewage effluent. Increased δ15N of organic matter after 1965 A.D. indicates changes in the dissolved inorganic nitrogen delivered to the lake. The relatively small increase in δ15N (∼0.6‰ ) is less than might be expected with nitrate loading from sewage and soils, and might be offset by the presence of nitrogen-fixing cyanobacteria with low δ15N values.

The development of language remains a theoretical mystery in many respects. There are similarities in the work of developmental theorists, physiological theorists and anthropological studies. Knowledge of the normal language development process for paediatric nurses and allied professionals is essential in order to identify the abnormal and therefore ensure early intervention with support services and treatment. Further research from a universal perspective is advocated.

Congenital hereditary endothelial dystrophy (CHED) is a disorder of the corneal endothelium and has been recognized to segregate in families with both autosomal dominant (AD) and autosomal recessive (AR) modes of transmission. AD-CHED has been previously linked to the pericentric region of chromosome 20. Posterior polymorphous dystrophy (PPMD), a corneal endothelial disorder showing phenotypic overlap with CHED, has also been previously genetically mapped to this region. The genetic interval containing AD-CHED is within the larger genetic interval containing the PPMD locus. This study sought to determine whether AR-CHED segregating in a consanguineous Saudi Arabian pedigree is linked to the previously mapped and overlapping loci for AD-CHED and PPMD on the pericentric region of chromosome 20. Forty members of a consanguineous Saudi Arabian pedigree segregating AR-CHED were ascertained. Short tandem-repeat polymorphic markers from the 20 cM interval on chromosome 20 containing both the PPMD and AD-CHED loci were used to genotype these individuals. LOD score analysis of the genotype data with the MENDEL software package utilizing a model of autosomal recessive inheritance with complete penetrance showed exclusion of CHED from the entire PPMD/AD-CHED interval by utilizing overlapping intervals of LOD scores of at least -2. The results obtained demonstrate that AR-CHED is not allelic to either AD-CHED or PPMD, although it has been proposed that AD-CHED may be allelic to PPMD. Thus, there are at least two genes responsible for CHED and PPMD.

We investigated microfossil assemblages in recent sediments from nine stations across Lake Ontario. Stephanodiscus niagarae was not present in any of these sediment samples, marking the taxon’s extirpation from its type locality. This observation documents the end of a general reduction in size and alteration in valve morphology associated with habitat disturbance. Stephanodiscus niagarae may have been directly eliminated from the lake, or sexual reproduction may have been delayed beyond the species’ ability to sustain numbers through asexual reproduction.

■ There is a need for further clarification of the concept of partnership ■ A philosophy of 'family-centred care' will require negotiation with, and commitment from, all concerned with care delivery in the ward and beyond ■ Paediatric nursing needs to adopt a flexible and non- judgmental approach in order to facilitate the needs of all families ■ The concept of 'partnership in care' is of benefit to families caring for sick children in the context of today's economic and political climate

Aulacoseira skvortzowii sp. nov. is a diatom taxon present in modern plankton assemblages and sedimentary deposits from Lake Baikal, Russia. It has been preuiously reported as A. islandica (0. Mull.) Sirnonsen, A. islan- late fall pelagic plankton community. C~~clotella min- uta dominates the modern assemblage whereas C. ornata and C. baicalensis have become much less abundant in recent years (Popovskaya 199 1, Flower 1993). The vernal phytoplankton is usually domi- nated by Aulacoseira baicalensis (K. Meyer) Simonsen. This filamentous centric taxon begins its develop- ment beneath clear ice as early as February and continues to dominate the plankton through May or June. Population numbers vary greatly from year to year, producing what are known as "Aulacoseira" years every 3-4 years, when A. baicalensis dominates the pelagic plankton. The endemic Cyclotella typi- cally have greater development during "Aulacoseira- poor" years. The controlling factors governing this cycling of populations are poorly understood but may be related to reproductive cycles.

Many states along the U.S. East Coast are engaged in offshore wind energy planning through the Renewable Energy Task Force process led by the Bureau of Ocean Energy Management (BOEM). Participants from federal, state, and local government use the task forces as a venue to share information and minimize potential conflicts between existing ocean uses and offshore wind farm construction and operations. Task force participants often only make information available in static map form, making comparisons between data sets challenging. To address this, the North and South Carolina Renewable Energy Task Forces are collaborating with the MarineCadastre.gov team to facilitate data sharing. The National Oceanic and Atmospheric Administration (NOAA) and BOEM have been collaborating since 2007 on MarineCadastre.gov, an integrated marine information system that provides jurisdictional, legal, physical, ecological, and ocean use data in a common geographic information system (GIS) framework. The MarineCadastre.gov website was developed in response to a call for a marine information system to support alternative energy development on the outer continental shelf in section 388 of the Energy Policy Act of 2005. Although the website has been designed specifically to support renewable energy siting within the U.S. outer continental shelf, it is also being used for various other ocean-related efforts. The MarineCadastre.gov website has three primary focus areas: Web map viewers and decision-support tools, a spatial data registry, and technical support and regional capacity building. The North and South Carolina Wind Energy Task Forces are combining national-scale data from the website with information specific to their planning areas into simple viewers available in the Map Gallery section of the website. This approach allows users to assess and minimize potential conflicts of offshore wind energy development and operation with existing ocean uses. Multiple issues, such as fishing, shipping, and defense, are viewed and considered simultaneously, in one location, allowing members of the task force to see their own data in a wider context. This enhances the utility of the information that was previously compared using static maps. Users can turn data layers on and off and pan and zoom to specific locations in the planning area as questions arise. The North and South Carolina Wind Energy Task Force data viewers are a simple but powerful mechanism for identifying areas of potential incompatibility, enhancing communication between task force members, and increasing the overall effectiveness of the task force process. The overarching goal of this work is to support the BOEM task forces in making sound decisions with the best available spatial information to facilitate responsible siting of offshore renewable energy infrastructure. This presentation will provide an overview of the primary focus areas of the MarineCadastre.gov project and its underlying technology, with particular attention given to the collaborations with the BOEM-led renewable energy task forces in North and South Carolina. Details on how these two BOEM task forces are incorporating use of the data viewers into their decision-making processes, the types of data being considered, and potential next steps for analyzing the spatial information in a group setting will be discussed.

Prior research has established an association between deployment and family violence, with insufficient evidence to identify when such violence occurs in relation to deployment and identification of mental illness in ADSM. This project will use: 1) longitudinal models to capture the temporal relationships between deployment, mental illness and family violence and 2) qualitative techniques to allow military stakeholders to evaluate Stage 1 findings and inform future interventions. This year we assembled our experts, obtained human subjects approvals, and acquired datasets. We now have our finalized cohort for our study period of interest. Our programmer is working intensively to clean the datasets so that we can link deployment/UIC/MOS records to substantiated reports of family abuse and medical claims data. Once this is done, we will move forward with formal data analyses and begin to answer our research questions. The last 3 months have been filled with progress and momentum, and we look forward to sharing results from our analyses in the upcoming months.

Purpose To describe a multigenerational family with autosomal dominant inheritance of cavitary optic nerve head (ONH) anomalies and abnormal ONH vasculature. Design Description of a single family with inherited eye disease. Methods A four-generation pedigree was investigated. Examination included visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and ophthalmoscopy. Visual fields and fundus photography were obtained when possible. Results Seventeen clinically affected individuals and two obligate carriers were identified. Most (64.7%) affected persons had bilateral involvement. Visual acuity in affected eyes ranged from 20/20 to no light perception. Although the appearance of affected nerves varied greatly, most lacked a well-formed central retinal artery and instead had multiple radial cilioretinal arteries. Prominent cupping was seen in most affected nerves. Four individuals for whom information was available were treated for glaucoma, but none had documented elevated IOP. Four eyes of two patients demonstrated progressive ONH cupping at normal IOPs. Nine (56.3%) of the 16 individuals for whom we had data had evidence of serous macular detachments; five of these had bilateral macular disease. Conclusions A large family with autosomal dominant inheritance of cavitary ONH anomalies and abnormal vasculature is presented. Clinical phenotypes varied markedly. Progressive ONH cupping was documented in four eyes of two patients. Genetic linkage analysis of this family has identified the chromosomal location of a gene responsible for ONH development. This may provide insight into the pathogenesis of glaucomatous ONH damage.

Objective To report a novel de novo vitelliform macular dystrophy ( VMD2 ) mutation in a patient with Best macular dystrophy. Methods Best-corrected visual acuity, dilated fundus examination, and electro-oculography were performed in a patient with Best macular dystrophy and his parents. Both the patient and his parents also had blood samples drawn, and their DNA was analyzed by direct genomic sequencing. Results A heterozygous VMD2 gene missense mutation in exon 2 (Thr6Ala [ACA>GCA]) was identified in the proband. This mutation was not present in his clinically unaffected parents. Conclusions A novel de novo mutation in the VMD2 gene was found in a patient whose phenotype and electro-oculographic findings were characteristic of Best macular dystrophy, whereas both parents were phenotypically and genetically unaffected. The findings in this family document that a de novo mutation needs to be considered when an isolated family member is found to have a Best disease phenotype.

Background Von Hippel–Lindau (VHL) disease is a dominantly inherited cancer syndrome. Since the identification of the VHL gene, at least 3 clinical-genetic subtypes of the disease have been recognized. Objectives To identify the specific abnormality in the VHL gene and to correlate it with the prevalence and severity of ocular involvement in a large family with VHL disease. Methods A longitudinal clinical study and DNA analysis of 24 family members. Results All 14 affected family members exhibited a thymine-to-cysteine change at nucleotide 505 (T505C) in exon 1 of the VHL gene, consistent with the clinical diagnosis of VHL disease subtype 2A. Two asymptomatic gene carriers were also identified. Seventy-five percent (12/16) of the gene carriers had 1 or more ocular angiomas. The mean number of ocular angiomas per gene carrier was 3.3. Six eyes had optic disc angioma. Five gene carriers(31%) had lost vision because of angiomatosis. Cerebellar hemangioblastomas were present in 4 patients (25%) and pheochromocytomas in 11 (69%). No patient was found to have a renal cell carcinoma. Conclusions The family shows a low susceptibility to renal carcinoma consistent with the clinical diagnosis of VHL disease type 2A. The prevalence and severity of ocular angiomatosis in this subtype do not significantly differ from those of the other more common subtypes of VHL. Recognition of the VHL disease 2A phenotype suggests the presence of a specific mutation (T505C) in the VHL gene. Confirmation of this genotype increases the clinician's ability to provide favorable prognostic information to affected family members.

Posterior polymorphous dystrophy (PPMD) is an autosomal dominant disorder of the cornea that is clinically recognized by the presence of vesicles on the endothelial surface of the cornea. The corneal endothelium is normally a single layer of cells that lose their mitotic potential after development is complete. In PPMD, the endothelium is often multi-layered and has several other characteristics of an epithelium including the presence of desmosomes, tonofilaments, and microvilli. These abnormal cells retain their ability to divide and extend onto the trabecular meshwork to cause glaucoma in up to 40% of cases. A large family with 21 members affected with PPMD was genotyped with short tandem repeat polymorphisms distributed across the autosomal genome. Linkage was established with markers on the long arm of chromosome 20. The highest observed LOD score was 5.54 (theta = 0) with marker D20S45. Analysis of recombination events in four affected individuals revealed that the disease gene lies within a 30cM interval between markers D20S98 and D20S108.

To determine the histidine frequency in patients with the cuticular drusen phenotype of age-related macular degeneration (AMD).Fifty individuals were identified who met the criteria for the cuticular drusen phenotype using a standard threshold photograph. We genotyped DNA samples using a polymerase chain reaction-based restriction digest assay. Seven hundred individuals with typical AMD and 252 controls were also genotyped. Fisher exact test was used to analyze the significance of allele frequency differences.The histidine variant was present in 70% (frequency +/- SE, 0.70 +/- 0.05) of the cuticular cohort, 55% (frequency +/- SE, 0.55 +/- 0.01) of the more typical AMD cases, and 34% (frequency +/- SE, 0.34 +/- 0.02) of controls. The association between the cuticular drusen phenotype and the histidine allele was highly significant (P = .003; odds ratio, 2.0; 95% confidence interval, 1.21-3.07; vs AMD cases P.001; odds ratio 4.54; 95% confidence interval, 2.79-7.50; vs controls). Genotype distribution between the 3 groups was similarly significant (P.001).The cuticular drusen phenotype is highly associated with the Tyr402His variant of the complement factor H (CFH) gene. The significantly higher histidine allele frequency in this group compared with the typical AMD cohort suggests that the complement cascade may play a greater role in the pathogenesis of the cuticular drusen subtype than in AMD as a whole.The c.1204TC, p.Tyr402His allelic variant in the CFH gene is associated with a 3-fold increased risk for AMD. A high frequency of the histidine allele has also been noted in patients with membranoproliferative glomerulonephritis type II.

Objectives To identify a congenital nystagmus locus on the X chromosome and to characterize the phenotype of a 4-generation family affected with congenital nystagmus and color deficiency. Methods Sixty-five patients underwent an eye examination, including evaluation for the presence of nystagmus and color vision abnormalities. Affected patients and obligate carriers of the congenital nystagmus mutation were genotyped with short tandem repeat polymorphisms located on the X chromosome, and these data were subjected to linkage analysis. Results Fourteen patients were affected with a horizontal, conjugate, congenital nystagmus. All examined patients had a visual acuity of 20/60 or better. There were no associated ocular or systemic findings except that 18 of the family members had deficient red-green color vision, which was classified as deuteranomaly (the most common form of anomalous trichromacy). Five patients exhibited nystagmus and deuteranomaly. Significant linkage was demonstrated between the nystagmus phenotype and 11 markers from Xq. The maximum lod score was 4.84 (θ = 0) and was obtained with marker DXS8041 . Analysis of recombinants defined the disease interval to lie between markers ATA59C05 and DXS1192 (a 5.4-centimorgan region). The proximity of this locus to the red-green opsin gene cluster (11 centimorgans more telomeric) explains the frequent coexistence of nystagmus and color vision deficiency in this family. Conclusions We have identified the genetic locus of the X-linked congenital nystagmus gene in this family. The critical interval in this report is less than half the size of the previously described nystagmus locus. These findings will aid in identifying the gene responsible for this condition.