Aim
Various early intervention programmes have been developed in response to the high rate of neurodevelopmental problems in very preterm infants. We investigated longitudinal effects of the Infant ...Behavioral Assessment and Intervention Program on cognitive and motor development of very preterm infants at the corrected ages of six months to five and a half years.
Methods
This randomised controlled trial divided 176 infants with a gestational age <32 weeks or birthweight <1500 g into intervention (n = 86) and control (n = 90) groups. Cognitive development and motor development were assessed with the Bayley Scales of Infant Development at the CAs of six, 12 and 24 months and at five and a half years with the Wechsler Preschool and Primary Scale of Intelligence and the Movement Assessment Battery for Children.
Results
We found significant longitudinal intervention effects (0.4 SD, p = 0.006) on motor development, but no significant impact on cognitive development (p = 0.063). Infants with bronchopulmonary dysplasia showed significant longitudinal intervention effects for cognitive (0.7 SD; p = 0.019) and motor (0.9 SD; p = 0.026) outcomes. Maternal education had little effect on intervention effects over time.
Conclusion
The Infant Behavioral Assessment and Intervention Program led to long‐term developmental improvements in the intervention group, especially in infants with BPD.
Les connaissances et compétences en nutrition des services de soins sont souvent parcellaires et peuvent compromettre tant l’évaluation que la prise en charge nutritionnelles des patients ...hospitalisés. Le but de cette étude a été d’évaluer si une action de formation et d’accompagnement de services de soins dans le champ nutritionnel permettait d’améliorer cet état de fait.
Nous avons collecté, à partir des données fournies par le département d’informatique médicale, 9051 dossiers de patients hospitalisés, 3575 concernant les données les 4 mois précédent l’intervention, 3501 concernant les données collectées pendant 4 mois un semestre après la fin de l’intervention et 1995 concernant une 2e évaluation réalisée 1 an plus tard. Les services volontaires ont été la chirurgie digestive, la néphrologie, la cardiologie, la gastro-entérologie et la chirurgie cardiaque. L’intervention a consisté à rappeler aux équipes médico-soignantes les paramètres cliniques et paracliniques nécessaires au diagnostic nutritionnel ainsi que les modalités habituelles de prise en charge thérapeutique nutritionnelle. Un accompagnement diététique ciblé « au fil de l’eau » était également mis en place en fonction des besoins exprimés par les équipes et poursuivi pendant toute la durée de l’intervention. Les comparaisons des distributions des variables étudiées ont été réalisées par le test du Chi2.
D’une manière générale, les formations et l’accompagnement des unités de soins dans le champ nutritionnel ont permis d’améliorer le diagnostic nutritionnel avec une augmentation significative de la mesure de la taille (p<0,001), du calcul de l’IMC (p<0,001), de la recherche d’une perte d’appétit (p<0,001), du dosage de l’albumine (p<0,001) ou de la pré-albumine (p<0,001), du calcul des besoins nutritionnels (p<0,001) ou du recours à une diététicienne (p<0,001). Les diagnostics de dénutrition modérée ou sévère sont également plus fréquents (p<0,05). La prise en charge nutritionnelle est également meilleure que ce soit au niveau de la prescription des CNO (p<0,001), de la nutrition entérale (p<0,001) ou de la nutrition parentérale (p<0,001), ces améliorations thérapeutiques étant significativement renforcées par les conseils de la diététicienne (p<0,05). Les améliorations observées sont quantitativement variables mais globalement proportionnelles à la prévalence des patients dénutris pris en charge. Ainsi, elles sont quantitativement plus faibles en cardiologie ou en chirurgie cardiaque et beaucoup plus importantes dans les services de néphrologie ou de gastro-entérologie.
En conclusion, pouvoir mettre à disposition des équipes médico-soignantes une formation et une assistance prolongée dans le champ nutritionnel permet un renforcement des compétences des équipes en matière de soins nutritionnels, avec à la clef, une amélioration significative du diagnostic et de la prise en charge nutritionnelle des patients dénutris. Cette assistance paraît par ailleurs être plus profitable aux services où la prévalence des patients dénutris est plus élevée, même si les améliorations sont observées dans l’ensemble des unités.
Residual dipolar couplings (RDC), measured by dissolving proteins in dilute liquid crystal media, or by studying naturally paramagnetic molecules, have rapidly become established as routine ...measurements in the investigation of the structure of macromolecules by NMR. One of the most obvious applications of the previously inaccessible long-range angular information afforded by RDC is the accurate definition of domain orientation in multi-module macromolecules or complexes. In this paper we describe a novel program developed to allow the determination of alignment tensor parameters for individual or multiple domains in macromolecules from residual dipolar couplings and to facilitate their manipulation to construct low-resolution models of macromolecular structure. For multi-domain systems the program determines the relative orientation of individual structured domains, and provides graphical user-driven rigid-body modeling of the different modules relative to the common tensorial frame. Translational freedom in the common frame, and equivalent rotations about the diagonalized (x,y,z) axes are used to position the different modules in the common frame to find a model in best agreement with experimentally measured couplings alone or in combination with additional experimental or covalent information.
A novel program has been developed for the interpretation of 15N relaxation rates in terms of macromolecular anisotropic rotational diffusion. The program is based on a highly efficient simulated ...annealing/minimization algorithm, designed specifically to search the parametric space described by the isotropic, axially symmetric and fully anisotropic rotational diffusion tensor models. The high efficiency of this algorithm allows extensive noise-based Monte Carlo error analysis. Relevant statistical tests are systematically applied to provide confidence limits for the proposed tensorial models. The program is illustrated here using the example of the cytochrome c' from Rhodobacter capsulatus, a four-helix bundle heme protein, for which data at three different field strengths were independently analysed and compared.
Botanical macrofossil analysis of a more than 9000
years old, radiocarbon dated peat sequence of a moss peat bank from South Georgia, shows a clear evolution in the vegetation. Seven ecological ...phases could be distinguished and they can be interpreted in terms of climate development during the Holocene. Until 2200
years ago,
Warnstorfia fontinaliopsis was the dominant moss species pointing to a wet environment. Lower numbers of this species in association with the presence of drier species are assumed to indicate drier periods, such as occurring between ca 6000–5200 and 4400–3400
cal yr BP. The most prominent and definitive vegetation change took place around 2200
cal yr BP. A
Polytrichum–Chorisodontium moss peat bank was formed, which is still growing there today. The forcing mechanism for this vegetation change is thought to be a temperature decrease, rather than a precipitation decrease. This conclusion is mainly based on the fact that, today, moss peat banks have their optimal occurrence range in the maritime Antarctic, a region were the mean annual temperature is ca 4
°C lower than on South Georgia. The remarkable change in the moss bank vegetation at 2200
cal yr BP raises the question whether this moment was only a short climatic deterioration, or a definitive change to a cooler and wetter climate after a Holocene climatic optimum period.
A well‐preserved early Middle Palaeolithic site set against a wider northwestern European context. The shift from Lower to Middle Palaeolithic in northwestern Europe (dated to around 300,000–250,000 ...years ago) remains poorly understood and underexplored compared to more recent archaeological transitions. During this period, stone tool technologies underwent significant changes but the limited number of known sites and the general low spatio‐temporal resolution of the archaeological record in many cases has impeded detailed behavioural inferences. Brickyard‐quarrying activities at Kesselt‐Op de Schans (Limburg, Belgium) led to the discovery and excavation of a well‐preserved early Middle Palaeolithic level buried beneath a 10 m thick loess-palaeosol sequence. The present volume offers a comprehensive report on the site, dated to around 280,000 years ago, set against a wider northwestern European context. An in‐depth study of the lithic assemblage, including an extensive refitting analysis, provides detailed information on the technological behaviour of prehistoric hominins in the Meuse basin during this crucial time period.
Aim: The aim of this study is to investigate the reliability, sensitivity and responsiveness of the Infant Behavioral Assessment (IBA) to evaluate neurobehavioural organization in very preterm ...infants.
Methods: Videotaped assessments of very preterm infants participating in a recent trial served to evaluate a standardized IBA observation. Inter‐rater reliability was based on 40 videos scored by two independent observers, using percentage agreement and weighted Kappa’s. Sensitivity was evaluated by comparing the IBA results of 169 infants at 35–38 weeks postmenstrual age, dichotomized according to two developmental risk factors. For responsiveness, the effect size (ES) was calculated between 0 and 6 months corrected age in all intervention and control infants and in subgroups of high‐risk intervention and control infants with oxygen dependency ≥28 days.
Results: Inter‐rater agreement was 93% in the total assessment; Kappa agreement was moderate to good in the behavioural categories. Significant differences were found between groups with or without risk factors. Larger differences between ESs in the randomized groups with oxygen dependency ≥28 days than in the total randomized groups reflect the responsiveness of the IBA.
Conclusion: In this study, we found satisfactory to good clinimetric characteristics of the IBA in very preterm born infants.
Orientational and novel long-range order restraints available from paramagnetic systems have been used to determine the backbone solution structure of the cytochrome c′ protein to atomic resolution ...in the complete absence of restraints derived from the nuclear Overhauser effect. By exploiting the complementary geometric dependence of paramagnetic pseudocontact shifts and the recently proposed Curie-dipolar cross correlated relaxation effect, in combination with orientational constraints derived from residual dipolar coupling, autorelaxation rate ratios and secondary structure constraints, it is possible to define uniquely the fold and refine the tertiary structure of the protein (0.73 Å backbone rmsd for 82/129 amino acid residues) starting from random atomic Cartesian coordinates. The structure calculation protocol, developed using specific models to describe the novel constraint interactions, is robust, requiring no precise a priori estimation of the various interaction strengths, and provides unambiguous convergence based only on the value of the target function. Tensor eigenvalues and their component orientations are allowed to float freely, and are thus simultaneously determined, and found to converge, during the structure calculation.
In protein NMR the assignment of nuclear spin resonances is a prerequisite for all subsequent applications, such as studies of ligand binding, protein-DNA interactions, and dynamics. Resonance ...assignment is a time consuming step even when the 3D x-ray structure of the protein is available. A new strategy is presented to solve the “inverse” assignment problem, which is the determination of the NMR resonance assignment from a known 3D protein structure. The protocol employs NMR data in the form of residual dipolar couplings and chemical shifts, while it does not require any sequential NMR connectivity information. The assignment problem is mathematically formulated in terms of a weighted matching problem that can be computationally efficiently solved by a combinatorial optimization algorithm. The protocol is applied to ubiquitin using two or three residual dipolar couplings per amino acid measured in Pfl phage medium together with chemical shift information. The algorithm yields for more than 90% of the protein backbone resonances the correct assignment.
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