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OBJECTIVE: Police officers experience many traumatic events over the course of their career, often resulting in posttraumatic stress disorder (PTSD) and associated psychological distress. Studies have investigated the efficacy of interventions aimed at reducing symptoms of PTSD experienced by police officers, but lacking are studies investigating the impact of PTSD on positivity, a construct we define as a latent variable estimated using self-report measures of optimism, gratitude, self-compassion, and mindfulness. The present study carried out a path analysis of a model testing the hypothesis that PTSD would be associated with increased psychological distress and decreased positivity, both of which influence well-being. The model also evaluated associations between constructs that could be modified through interventions to increase well-being-associations between posttraumatic growth, social support, physical activity and psychological distress, positivity, and well-being. METHOD: Police officers (n = 506) completed an online survey that included self-report measures of the constructs included in the model being tested. RESULTS: The model tested produced fit indices of root mean square error of approximation (RMSEA) = .089; comparative fit index (CFI) = .960; Tucker-Lewis index (TLI) = .93; standardized root mean square residual (SRMR) = .041 and R² = .79. Results found that neither PTSD or psychological distress had a direct effect on well-being. Psychological distress indirectly influenced well-being by lowering levels of positivity, while positivity was associated with higher scores on the measure of well-being. CONCLUSIONS: The implication of the results is that interventions aimed at enhancing positivity could be expected to improve well-being in police officers and offering traditional therapies together with positivity enhancing therapies may have additional benefits over either alone. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives Despite a large evaluation literature for interventions aiming to improve the lives of families affected by parent substance misuse, very few studies have examined how families change when engaged with treatment. This study examines the interactive process of change in parent psychopathology and mindful parenting during participation in the Parents under Pressure (PuP) program for parents engaged in community addiction services. Methods Parents (n = 164) provided baseline, mid- and end-treatment measures of parent psychopathology and mindful parenting. Cross-lagged modelling was used to examine therapeutic process of change. Results Parent psychopathology decreased, and mindful parenting increased from baseline to end-treatment (ps p = .005). Examination of the mindful parenting dimensions revealed variation in the therapeutic process of change. While higher levels of Non-Judgemental Acceptance of Parental Functioning (NJAPF) at baseline predicted lower psychopathology at mid-treatment (p = .03), higher levels of Compassion for Child (CC) at baseline predicted greater psychopathology at mid-treatment (p = 0.004). Higher levels of NJAPF mid-treatment predicted lower psychopathology upon treatment completion (p = .023), yet higher levels of Emotional Awareness of Child (EAC) at mid-treatment predicted greater psychopathology upon treatment completion (p = .023). Lower parent psychopathology at mid-treatment predicted higher levels of LFA, EAC, Self-Regulation in Parenting and NJAPF upon completion of the PuP program (ps Conclusions The findings highlight the importance of reducing parent psychopathology as a precursor to more mindful parenting and also provide new evidence regarding the way in which variation in mindful parenting dimensions influences the therapeutic process of change.

Background: Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. Methods: We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. Findings: Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. Interpretation: Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. Funding: The UK National Institute for Health Research Health Technology Assessment Programme.

Introduction A core tenet of occupational therapy is that engagement in meaningful activities is integral for a person’s health and wellbeing. Childhood adversity can have lifelong impacts on physical and mental health; however, the effects of childhood experiences are dependent on the presence of susceptibility factors, including sensory processing sensitivity. To date, the effects of childhood adversity and sensory processing sensitivity have not been investigated for meaningful activity engagement. This study seeks to determine whether childhood adversity is related to engagement in meaningful activities in adulthood and whether this relationship is moderated by sensory processing sensitivity. Method Using convenience snowball sampling, a cross-sectional online survey was conducted with 328 adults. Participants completed a battery of questionnaires, including the Risky Families Questionnaire, Highly Sensitive Person Scale and Engagement in Meaningful Activities Scale. Results Correlational analyses found that childhood adversity was related to significantly less meaningful activity engagement in adulthood, but this relationship was not moderated by sensory processing sensitivity. Conclusion This study showed, for the first time, that a history of childhood adversity is linked to less engagement in meaningful activities in adulthood. While further research is needed, supporting meaningful activity engagement may be necessary for adults who experienced childhood adversity.

Introduction Autonomic nervous system functioning is theorised to underpin individual differences in sensory processing, with a small amount of supporting evidence. Despite recognition of the need to measure the balance between sympathetic and parasympathetic activity, most studies have measured only one of these systems. This study investigated whether sensory processing patterns are related to autonomic balance for young adults at rest and in response to a sensory-based stressor. Method In this cross-sectional laboratory study, 100 young adults completed the adolescent/adult sensory profile. Heart rate variability and pre-ejection period were recorded before, during and after a coldpressor task. Results Relationships between sensory processing patterns and autonomic balance varied by gender. In males, low sensory thresholds were generally related to a state of reciprocal sympathetic activation. In females, low thresholds were associated with greater autonomic reactivity in response to the coldpressor. Conclusion This study showed, for the first time in young adults, that sensory processing patterns may be linked to patterns of autonomic balance. Therapists should be aware that young men with low sensory thresholds may be more likely than others to exhibit a resting state of sympathetic hyperarousal and further research should investigate whether this impacts their daily functioning and wellbeing.

HR pathway mutations

Purpose: A significant number of women with serous ovarian cancer are intrinsically refractory to platinum-based treatment. We analyzed somatic DNA copy number variation and gene expression data to identify key mechanisms associated with primary resistance in advanced-stage serous cancers.Experimental Design: Genome-wide copy number variation was measured in 118 ovarian tumors using high-resolution oligonucleotide microarrays. A well-defined subset of 85 advanced-stage serous tumors was then used to relate copy number variation to primary resistance to treatment. The discovery-based approach was complemented by quantitative-PCR copy number analysis of 12 candidate genes as independent validation of previously reported associations with clinical outcome. Likely copy number variation targets and tumor molecular subtypes were further characterized by gene expression profiling.Results: Amplification of 19q12, containing cyclin E (CCNE1), and 20q11.22-q13.12, mapping immediately adjacent to the steroid receptor coactivator NCOA3, was significantly associated with poor response to primary treatment. Other genes previously associated with copy number variation and clinical outcome in ovarian cancer were not associated with primary treatment resistance. Chemoresistant tumors with high CCNE1 copy number and protein expression were associated with increased cellular proliferation but so too was a subset of treatment-responsive patients, suggesting a cell-cycle independent role for CCNE1 in modulating chemoresponse. Patients with a poor clinical outcome without CCNE1 amplification overexpressed genes involved in extracellular matrix deposition.Conclusions: We have identified two distinct mechanisms of primary treatment failure in serous ovarian cancer, involving CCNE1 amplification and enhanced extracellular matrix deposition. CCNE1 copy number is validated as a dominant marker of patient outcome in ovarian cancer.

TP53 mutations

Purpose: Women with epithelial ovarian cancer generally have a poor prognosis; however, a subset of patients has an unexpected dramatic and durable response to treatment. We sought to identify clinical, pathological, and molecular determinants of exceptional survival in women with high-grade serous cancer (HGSC), a disease associated with the majority of ovarian cancer deaths.Experimental Design: We evaluated the histories of 2,283 ovarian cancer patients and, after applying stringent clinical and pathological selection criteria, identified 96 with HGSC that represented significant outliers in terms of treatment response and overall survival. Patient samples were characterized immunohistochemically and by genome sequencing.Results: Different patterns of clinical response were seen: long progression-free survival (Long-PFS), multiple objective responses to chemotherapy (Multiple Responder), and/or greater than 10-year overall survival (Long-Term Survivors). Pathogenic germline and somatic mutations in genes involved in homologous recombination (HR) repair were enriched in all three groups relative to a population-based series. However, 29% of 10-year survivors lacked an identifiable HR pathway alteration, and tumors from these patients had increased Ki-67 staining. CD8+ tumor-infiltrating lymphocytes were more commonly present in Long-Term Survivors. RB1 loss was associated with long progression-free and overall survival. HR deficiency and RB1 loss were correlated, and co-occurrence was significantly associated with prolonged survival.Conclusions: There was diversity in the clinical trajectory of exceptional survivors associated with multiple molecular determinants of exceptional outcome in HGSC patients. Concurrent HR deficiency and RB1 loss were associated with favorable outcomes, suggesting that co-occurrence of specific mutations might mediate durable responses in such patients. Clin Cancer Res; 24(3); 569–80. ©2017 AACR.See related commentary by Peng and Mills, p. 508

Histotype classification

Revised Supplementary Data, containing Supplementary Methods, Supplementary Figures, Supplementary Tables Supplementary Figure S1. Outline of cohort selection and analyses. Supplementary Figure S2. Clinical response and therapy course of 96 patients with exceptional responses to chemotherapy. Supplementary Figure S3. Distribution and type of TP53 mutations. Supplementary Figure S4. RB1 protein expression altered by genomic inactivation. Supplementary Figure S5. Characterization of CD8 and Ki-67 in tumors according to homologous recombination mutation status. Supplementary Table S2 Immunohistochemical analysis: primary antibodies and staining conditions Supplementary Table S3 Homologous recombination and DNA repair panel Supplementary Table S6 Comparison of molecular alteration prevalence between clinical subgroups Supplementary Table S7 Patient characteristics of tissue microarray cohort

Supplementary Data from Integrated Genome-Wide DNA Copy Number and Expression Analysis Identifies Distinct Mechanisms of Primary Chemoresistance in Ovarian Carcinomas

Background and aims Family‐focused interventions can improve family functioning when parents have substance use problems. However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi‐site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family‐focused intervention for parents with substance use and other problems, and treatment‐as‐usual (TAU). Design Secondary analysis of data: multi‐level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross‐lagged models. Setting Community‐based family support services in the United Kingdom. Participants Parents (n = 100) attending community‐based addiction services with children aged 2.5 years or younger. Measurements Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time‐points with the observed variables parental emotion dysregulation and child abuse potential. Findings Increased child age [Z = 2.14, 95% confidence interval (CI) = 0.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (Z = 2.48, 95% CI = –2.76, −0.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post‐treatment (P

Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Effective parent functioning is a key predictor of functional outcomes for children with persistent pain. It is therefore important to identify factors that support or limit functioning in parents of these children. Child and parent attachment and child sensory processing patterns have been identified as risk-factors for parent functioning in healthy samples. Our study extends current research by examining whether parent and child attachment patterns and child sensory processing patterns are related to parent functioning in families of children with persistent pain. Using a cross-sectional design, data was collected at a tertiary pain management clinic from 98 parent-child dyads (i.e., a child or adolescent with persistent pain and one parent). Standardized questionnaires were used to assess parent and child attachment patterns, child sensory processing patterns, child pain intensity, and eight domains of parent functioning. Regression analyses revealed that parent attachment avoidance was significantly related to poorer overall parent functioning and three functioning domains: depression, partner relationship, and leisure. Child attachment avoidance was related to higher parental strain and the use of fewer protective parenting behaviors. Parent and child attachment anxiety and child sensory processing patterns were not significantly related to parent functioning. Findings suggest that parent and child attachment avoidance warrant further consideration with regards to parent functioning in clinical settings where children present with persistent pain. This may aid in identifying parents who are at-risk of poorer functioning and could guide the use of attachment-informed interventions for families of children with persistent pain.

Severe and persistent conduct problems in children during the primary school years are associated with school exclusion, increased risk of delinquency and early substance abuse. Literature reviews and consultation with experts in the field were used to better understand the factors that contribute to severe and persistent conduct problems and to identify the principles and potential methods to be included in a new intervention. Grounded in an ecological perspective, an innovative, multimodal intervention, the Helping Families Programme, has been developed. It uses a modular approach to systematically address parent behaviour, cognition and emotion across five key risk factor domains: parental mood and dysregulation; parent-child, family and school relationships; substance misuse; social support and networks; and managing life events and crises. Initial piloting of the Programme has offered early support for the potential value of the underlying principles and methods of the Programme.

Background: The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence. Design: 273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest. Setting: A public hospital alcohol and drug clinic. Measurements: The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale–Cannabis were completed, along with measures of cannabis consumption. Findings: The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy. Conclusions: Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.

Pre-birth risk assessment is a process by which circumstances affecting an unborn child can be identified and support for mother and infant embedded. This mixed methods study describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme to assess parenting capacity and provide support pre- and post-birth for ‘at risk’ women. Sixty-eight pregnant women referred to children's social care services were allocated to the pre-birth assessment and care pathway (n = 35) or to routine care (n = 33). Standardised measures of psychological distress, social support and alcohol measured change for the women in the assessment and care pathway. Twenty women who provided pre- and post-data reported significant improvements on all measures except alcohol use. Safeguarding outcomes at 12 months were obtained for both groups using administrative data. Forty-two per cent of the infants whose mothers received the pre-birth assessment and care pathway showed an improvement in child protection status compared to 14 per cent of the routine care infants. Safeguarding status deteriorated or stayed the same in 52 per cent of the routine cases compared to 26 per cent of those receiving the pathway. Qualitative data revealed that the pathway was acceptable and helpful to service users and service providers. Copyright © 2017 John Wiley & Sons, Ltd. ‘Describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme’ Key Practitioner Messages The current project found that a community-based pre-birth assessment and care pathway with high-risk pregnant women was feasible and acceptable for practitioners and service users. The pathway began mid-pregnancy and support was provided following the birth of the infant for up to 12 months. Over 40 per cent of infants whose mothers were allocated to the pre-birth risk assessment pathway showed improvements in child safeguarding status at 12 months.

Background Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent–child relationship. Aims The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent–child relationship and the use of mindfulness-based strategies for both children and parents. Methods This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. Results Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. Conclusions and implications The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children.

In this article, the findings of research that had, as one aim, the exploration of the role of decision-making tools and practice frameworks in supporting the decision making of practitioners working with children and families in non-government agencies in Queensland are presented. Semi-structured interviews were conducted with 30 frontline practitioners in three agencies in five different locations. A general finding was that practitioners used a range of different tools and frameworks and found them supportive. The pertinence of these findings is discussed in relation to recent developments in the provision of services for children and families in Queensland, namely the new funding of non-government agencies to provide early intervention supportive services to children and families and the implementation of a single practice framework to guide practice across the sector. Areas for future research in Queensland are identified to further investigate the role of tools in frontline practice with children and families and which may also contribute to debates more broadly about the development and implementation of practice frameworks to support practitioners.

Objective: Research has highlighted the role of gender in the expression of aggression. While boys display higher levels of physical aggression, girls appear to display higher levels of relational aggression. It is proposed that the expression of relational aggression may be associated, at least in part, with a child's development of language skills. The aim of the present study was to investigate the role of expressive and receptive language in the expression of relational aggression. Method: A sample of 106 four to six-year-old Iranian children completed a test of language ability while their teachers completed a rating scale measuring the children's expression of relational aggression. Results: Results supported the hypothesis that language skills play an important role in the development of relational aggression. Teachers reported that girls displayed significantly more relational aggression that boys. Girls were also found to have higher receptive and expressive language than boys. Finally, a mediation analysis found that language skills mediated the relationship between gender and relational aggression. Conclusions: The results suggest that gender differences in the expression of relational aggression may be related to gender differences in the development of language as opposed to gender per se.

Interest in the application of mindfulness-based intervention for the treatment of psychological disorders and promotion of wellbeing has grown exponentially in recent years. Mindfulness-based interventions have been found to be beneficial for treatment of various forms of psychopathology as well as improve psychological wellbeing and enhance physical health. Little research has investigated for whom and under what conditions training people to use mindfulness-based therapeutic techniques is most effective. Recent studies have found evidence that individual differences in personality traits are associated with mindfulness. For example, neuroticism has been found to be negatively associated with mindfulness. These associations raise the possibility that individual differences in personality may potentially moderate the effectiveness of mindfulness-based interventions. In the present study we draw on Gray's revised Reinforcement Sensitivity Theory (r-RST) to examine relationships between personality traits, mindfulness and psychological distress. We found that the Flight, Fight, Freeze system mediated the relationship between trait mindfulness and psychological distress, while trait mindfulness moderated the relationship between the Flight, Fight, Freeze system and psychological distress. Both results are consistent with the suggestion that acquiring the skills from learning and practicing mindfulness techniques is potentially useful, particularly for threat-sensitive individuals with low to moderate levels of trait mindfulness.

The over-representation of Aboriginal and Torres Strait Islander children in the child protection is a serious concern in Australia. A proportion of this group of children may have been removed from families who are providing an adequately safe and nurturing environment, reflecting false positive errors in decision making. Assuming this to be true, we draw on the decision-making ecology model of judgement and decision making in child protection to speculate on possible causes of such errors. This model suggests that false positive errors would occur if the level of risk children face is estimated to be higher than is actually the case or if the decision threshold applied in making decisions to remove children from their family are too low. We present a discussion of factors that could potentially influence judgements and decision thresholds, which has implications for practice. It is argued that false positive errors are most likely to be avoided through more thorough and accurate assessments families. When assessing Aboriginal and Torres Strait Islander families, we argue that this requires a theoretically grounded, culturally informed framework to improve assessments and decrease the likelihood of false positive errors in decisions involving Aboriginal and Torres Strait Islander children in Australia.

BACKGROUND A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. OBJECTIVE This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. METHODS The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). RESULTS Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. CONCLUSIONS Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge.

Background There is growing interest in the provision of parenting support to substance misusing parents. Methods This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted. Results Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p Conclusions Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed.

Background: Individuals with fetal alcohol spectrum disorders (FASDs) can experience profoundimpairments and long-term adverse outcomes. This systematic review adopts a life span perspectiveproviding an extensive analysis of the available literature. Methods: Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge, CINAHL,ERIC, The Cochrane Central Register of Controlled Trials, and gray literature. Two reviewers independentlyscreened the title and abstract of each reference, and the methodological rigor of the includedstudies was assessed using the Effective Public Health Project assessment tool. Results: Thirty-two studies met the inclusion criteria, of which the vast majority targeted early tomiddle childhood. Two studies focused on early intervention in the postnatal period, and 6 studiesaimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidenceon improving self-regulatory difficulties for children with FASDs. Nine studies focused onimproving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptationof a well-validated social skills program. Three studies provided promising initial evidence that parentsand caregivers could benefit from support with child behavior and a further 4 studies provided educationand advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies wereaimed at supporting parents who were themselves affected by prenatal alcohol exposure. Conclusions: There is growing evidence for interventions that improve outcomes for early to middlechildhood. However, a lack of research exists outside of this developmental period. This lack ofresearch is concerning given the potential positive impact of early intervention, for individuals and,financially, for governments. In addition, the lack of interventions for adolescents and adults furtherhighlights the widening developmental gap and the potential influence of secondary disabilities for thisat-risk population. Refereed/Peer-reviewed

Children living in families with parental substance abuse are at high risk of child maltreatment and associated adverse outcomes. A trial of methadone-maintained parents randomised to the Parents under Pressure (PuP) parenting programme reported significant improvements in family functioning relative to standard care or a brief intervention, as indicated by a reduction in scores on the Child Abuse Potential Inventory. We sought to determine the cost-effectiveness of the PuP programme to inform policy and programme implementation. The cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment and sensitivity analyses were conducted. Compared to usual care, the PuP programme costs an additional AU$8777 (£4880) per family to deliver. Assuming the most conservative estimate of one in five cases of maltreatment prevented, a cost-effectiveness estimate of AU$43 975 (£24 451) per case of potential maltreatment prevented for the PuP group was obtained. This is significantly less than the estimated mean lifetime cost of a case of child maltreatment of AU$200 000 (2013 present value) (£110 000). For 100 families in this population treated with PuP, there would be a net present value saving of an estimated AU$3.1 million (£1.7 million).

Objective: To explore the differences in baseline respiratory sinus arrhythmia (RSA) between children with fetal alcohol spectrum disorder (FASD) and typically developing children (TDC) and to investigate whether children with FASD have the capacity to engage in a brief mindfulness exercise. Methods: Participants were 14 children with FASD and 20 TDC. RSA was measured at baseline, during, and following a mindfulness exercise. A mindfulness compliance checklist was completed to ascertain if children could follow the task instructions. Results: Both groups obtained high scores on the mindfulness compliance checklist. There was a trend for children with FASD to have lower baseline RSA compared to TDC. Children in both groups demonstrated an increase in RSA during the mindfulness task. Conclusions: Children with FASD could engage in a mindfulness task, and both groups showed an increase in RSA. Further research is needed to establish whether prolonged mindfulness practice could be beneficial.

Objectives The aim of this study was to test a new theoretical model of cannabis use incorporating biologically-based personality traits and social cognition. This biosocial cognitive theory (bSCT) has robust support in alcohol studies, but has not been applied to cannabis. The model proposes two pathways linking dimensions of impulsivity to cannabis use. The first predicts that the association between Reward Sensitivity (SR) and cannabis use is mediated by positive outcome expectancies. The second predicts that the relationship between Rash Impulsiveness (RI) and cannabis use is mediated by cannabis refusal self-efficacy. An extended version of this model was also tested and included a third pathway linking Punishment Sensitivity (SP) to cannabis use via higher negative outcome expectancies. Method Participants were 252 18-to-21-year-olds who completed questionnaires assessing cannabis use, personality and social cognition. Theoretical models were tested using structural equation modeling. Results The bSCT model provided a good fit to the data (CFI = 0.95; RMSEA = 0.07; SRMR = 0.06). Positive cannabis expectancies and refusal self-efficacy partially mediated the association between SR and cannabis use (p < 0.05). Cannabis refusal self-efficacy fully mediated the relationship between RI and cannabis use (p < 0.05). The addition of a third SP pathway did not improve model fit. Conclusions Consistent with alcohol studies, the association between impulsivity and cannabis use is largely mediated by social cognition. The bSCT may provide novel insights to inform prevention and treatment of problematic cannabis use.

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Introduction: Women with advanced epithelial ovarian cancer (EOC) are at a high risk of recurrence after standard therapy. TRX-E-002-1 (Kazia Therapeutics, Australia) is a novel, third generation benzopyran molecule that induces caspase-dependent and -independent apoptosis in CD44 positive ovarian cancer stem-like cells and CD44 negative ovarian somatic cancer cells. An ongoing trial aims to evaluate the safety, tolerability, pharmacokinetics and activity of intraperitoneal (IP) administered TRX-E-002-1 monotherapy and in combination with standard of care for recurrent EOC (NCT02903771). The dose escalation phase of this open-label, 2-part clinical trial has been completed. Methods: Women with platinum resistant, persistent or recurrent EOC were enrolled in a dose escalation study (Part A) to determine the maximum tolerated dose (MTD) of TRX-E-002-1 monotherapy (0.24-20 mg/kg). Patients were dosed weekly with single agent TRX-E-002-1 IP for the first 2 cycles after which add-on standard intravenous chemotherapy was allowed (cycles 3-8). Assessments included disease response, based on CA-125 and Response Evaluation Criteria in Solid Tumours, circulating epithelial tumour cells and stem cell markers. Results: Fourteen subjects were recruited to Part A of which 11 were evaluable. All 11 subjects completed ≥1 infusions of monotherapy with 3 completing 8 cycles; 1 subject is currently on active treatment. The MTD was established at 5 mg/kg based on the limiting toxicity of ileus syndrome (n=2) and safety signals of bowel obstruction (n=3) and abdominal pain (n=2). The pharmacokinetics of TRX-E-002-1 were characterised by a rapid increase in systemic concentrations with peak concentrations ranging from 9.81 to 6,100 ng/mL over ~0.4 to 4.6 hours after a single dose administration. Plasma concentrations in all subjects progressively declined to Conclusion: IP administered TRX-E-002-1 has clinical potential for the treatment of platinum resistant, recurrent or persistent epithelial ovarian, fallopian tube or primary peritoneal cancer. Additional subjects are being recruited to an expansion cohort study (Part B) to determine preliminary evidence of disease activity of this agent alone or when combined with standard of care (cycles 3-8). Enrolment to Part B commenced in Oct 2018 with 25% of the cohort being recruited to date. Citation Format: Jermaine Coward, Don Dizon, Ganessan Kichenadasse, Paul Harnett, Kathleen Moore, Minal Barve, Daniel Berg, James Garner. Phase I study of intraperitoneal TRX-E-002-1 in patients with persistent or recurrent ovarian cancer, fallopian tube cancer or primary peritoneal cancer: Results of dose-escalation phase [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT091.

Personality and cognitive processes are both related to alcohol use and misuse. A recent model of hazardous drinking referred, the 2-CARS model, postulates two major pathways to hazardous drinking. One pathway primarily involves the association between Reward Drive and Positive Outcome Expectancies, the second involves the association between Rash Impulsiveness and Drinking Refusal Self-Efficacy. In previous tests of the model, Drinking Refusal Self-Efficacy was found to have the most proximal impact on drinking, being directly influenced by Rash Impulsiveness, and indirectly influenced by Reward Drive through Positive Outcome Expectancies. The aim of the current study was to test the 2-CARS model in a larger independent sample. Results found that individuals with a strong Reward Drive showed higher Positive Outcome Expectancies, while individuals high in Rash Impulsiveness were more likely to report reduced Drinking Refusal Self-Efficacy. The present results also showed a theoretically unexpected pathway with a direct association between Rash Impulsiveness and Positive Outcome Expectancies. However, overall the results support the view that a greater understanding of hazardous drinking can be achieved by investigating the relationship between these personality and cognitive variables.

The adoption of evidence-based practice in social work has been widely promoted in recent years and with this, a growing emphasis on the evaluation of practice using well-validated and reliable measurement processes. The Department of Health's 'Framework for the Assessment of Children in Need and their Families' in the UK includes quantitative measures that form part of a systematic assessment of the needs of children and their families that includes assessment of parenting capacity and parental emotional state. The measure selected to assess parental mood was originally known as the Irritability, Depression and Anxiety Scale, and has been renamed within the Assessment Framework as the Adult Well-Being Scale. This instrument is designed to assess depression, anxiety, and inward and outward irritability. However, there has been relatively little contemporary evaluation of the reliability and validity of the measure, and the extent to which it measures the four constructs it is designed to assess. This research therefore conducted extensive analyses of the reliability, validity and underlying factor structure of the Adult Well-Being Scale. The four subscales did not demonstrate sound psychometric properties. At best a total score may be used as an indicator of 'overall psychological distress'.

We examined the utility of revised Reinforcement Sensitivity Theory (r-RST) in comparison with original Reinforcement Sensitivity Theory (o-RST) in further understanding psychopathology and well-being. In line with theory, we found o-BIS to be a non-specific predictor of anxiety and stress whereas r-BIS and r-FFFS scales were predictors of anxiety and stress. Consistent with the joint systems hypothesis, depression was associated with r-BIS, but only when r-BAS was low. The r-BAS, low o-BIS and low r-Freeze were the only predictors of psychological well-being. These findings suggest that r-BAS as we measured it reflects more functional approach behaviour than measures of o-BAS. Further, while o-BIS appears to be associated with broad negative affective states, the parsing of r-BIS from fear potentially provides r-RST with a more refined understanding of psychopathology and reduced well-being.

The developmental needs of infants during the first year of life have been emphasised by recent research from a variety of sources highlighting the crucial role that early parent–infant interaction plays. Infants identified as being at significant risk of maltreatment need adequate protection within a time frame consistent with their developmental needs. This briefing paper describes a new care pathway established within a UK-based social care team, which aims to provide early identification, intensive support, timely assessment and decision making for a group of highly vulnerable, pregnant women, their partners and their infants. The pathway of care is described and a case study is presented to illustrate this care pathway. A mother is referred at eighteen weeks of pregnancy and supported post birth for six months. The combination of supporting structured professional judgement by the inclusion of standardised tools and training in a programme specifically developed for high-risk families suggests that this pre-birth risk-assessment process warrants further evaluation.

Evidence suggests that children in out-of-home care function better when placed in kinship compared with foster care. Less is known about the functioning of children in the unique form of kinship care where grandparents are caring full-time for their grandchildren in informal care arrangements. As grandparent carers are increasingly taking on this role, it is timely to investigate the functioning of the children in this form of care and the characteristics of the grandparents themselves. We compared the functioning of children in the two types of care. We also investigated carer characteristics, including the relationship between child functioning, social support and daily hassles on carer stress. One hundred fourteen cares and 180 children were assessed on a range of demographic and clinical measures. Children in grandparent care were displaying better behavioural and adaptive functioning than children living with foster carers. Grandparent carers reported higher levels of distress in the carer role. Predictors of carer stress included severity of child behaviour problems and daily hassles. Both group of carers and the children in their care would benefit from increased support from treatment services.

Background: Mindfulness is the development of a nonjudgmental accepting awareness of moment-by-moment experience. Intentionally attending to one's ongoing stream of sensations, thoughts, and emotions as they arise has a number of benefits, including the ability to react with greater flexibility to events and sustain attention. Thus the teaching of mindfulness-based skills to children and their carers is a potential means of improving family relationships and helping children achieve more positive developmental outcomes through increased ability to sustain attention and manage emotions. We provide a review of recent studies evaluating mindfulness-based interventions targeting children, adolescents, and families in educational and clinical settings. Method: Searches were conducted of several databases (including Medline, PsychINFO and Cochrane Reviews) to identify studies that have evaluated mindfulness-based interventions targeting children, adolescents or families published since 2009. Results: Twenty-four studies were identified. We conclude that mindfulness-based interventions are an important addition to the repertoire of existing therapeutic techniques. However, large-scale, methodologically rigorous studies are lacking. The interventions used in treatment evaluations vary in both content and dose, the outcomes targeted have varied, and no studies have employed methodology to investigate mechanisms of change. Conclusions: There is increasing evidence that mindfulness-based therapeutic techniques can have a positive impact on a range of outcome variables. A greater understanding of the mechanisms of change is an important future direction of research. We argue that locating mindfulness-based therapies targeting children and families within the broader child and family field has greater promise in improving child and family functioning than viewing mindful parenting as an independent endeavor.

Background: The ability of children to solve problems is an important influence on the social-cognitive development of children. Parents and children who use problem-solving strategies display more positive parent-child relationships. It follows that parents will be more effective in promoting the children's development and healthy parent-child relationships if they are skilled in problem-solving strategies and encourage their children to use these strategies. Aim: The aim of the present study was to evaluate the short-term efficacy of a problem-solving skills program for Iranian parents (the ‘Raising a Thinking Child’ program) on the parent-child relationship. Materials and method: Sixty-four mothers of 4–8 year-old children participated voluntarily in 12 2-hour weekly workshops over a three month period. Parents were taught a procedure for problem-solving and provided with the opportunity to consider how the procedure could be applied in response to challenging behaviors of their children. The problem-solving strategies were taught as an alternative to ineffective approaches such as punishing and reprimanding. Results: Results indicated that teaching problem-solving skills to parents had a positive influence on a number of dimensions of parenting as measured by the Parent Child Relationship Inventory. Conclusion: Parents who attended the program felt more supported, more involved with their children and better able to balance limit setting and child autonomy.

Background: Severe and persistent conduct problems in children during the primary school years are associated with school exclusion, increased risk of delinquency and early substance abuse. Method: Literature reviews and consultation with experts in the field were used to better understand the factors that contribute to severe and persistent conduct problems and to identify the principles and potential methods to be included in a new intervention. Results: Grounded in an ecological perspective, an innovative, multimodal intervention, the Helping Families Programme, has been developed. It uses a modular approach to systematically address parent behaviour, cognition and emotion across five key risk factor domains: parental mood and dysregulation; parent-child, family and school relationships; substance misuse; social support and networks; and managing life events and crises. Conclusion: Initial piloting of the Programme has offered early support for the potential value of the underlying principles and methods of the Programme. © 2010 The Authors. Child and Adolescent Mental Health

The teaching of mindfulness skills is a central component of a number of therapies and has been successful in improving the functioning of individuals suffering from a range of clinical problems. Despite the apparent benefits of mindfulness skills training, most studies to date have targeted clinical samples with the aim of reducing specific symptomatology or general psychological distress. We evaluated a brief (three-session) group-based mindfulness training intervention with a community sample with the aim of enhancing life satisfaction or decreasing psychological distress. In addition, we aimed to determine whether any benefits would be associated with increases on a measure of mindfulness. Results showed that the intervention was successful in decreasing psychological distress and improving life satisfaction and that these benefits were observed in individuals who reported an increase on a measure of mindfulness. Overall, the results suggested that a brief mindfulness intervention can be beneficial for individuals in the community who may not be suffering serious symptoms of psychological distress but are aiming to derive a greater sense of life satisfaction.

Low-grade serous ovarian cancer (LGSC) responds poorly to platinum based chemotherapy and is characterized by activating RAS-MAPK pathway mutations, including oncogenic BRAF. Drugs that target this pathway are effective in BRAF-mutant melanoma but other cancer types, such as colorectal cancers, are less sensitive. Early phase trials report a 15% response rate to MEK inhibitors in LGSC patients, however it is not known which features may predict response. We aimed to determine clinical characteristics and treatment response in women with LGSC and to determine whether response to targeted pathway inhibition is associated with specific mutation profiles in LGSC cell lines. Tumor samples from a cohort of grade 1 and 2 serous ovarian cancer patients were analyzed using targeted, exome or whole genome sequencing. Patient characteristics, treatment and clinical outcome were assessed. Cell lines derived from patients with LGSC with known mutation profiles, AOCS2 (KRAS/BRAF/NRAS wild-type), MPSC1 (BRAFV600L, NRASQ16R), VOA1056 (NRASQ16R) and HCC5075 (KRASG12V), were treated with BRAF (dabrafenib) or MEK inhibitors (trametinib, pimasertib and binimetinib) and response was compared to cell lines derived from high-grade serous cancer (HGSC) and BRAF-mutant melanoma. Women diagnosed with grade 1 or 2 serous carcinoma between 1994-2015 were identified from 1654 invasive ovarian serous cancer cases in the Australian Ovarian Cancer Study and the GynBiobank. HGSC cases were excluded following histopathology review and TP53 mutation screening. Amongst 65 confirmed LGSC patients, 18 (27.7%) had a KRAS mutation, 9 (13.8%) had a BRAF mutation and 7 (10.8%) had a NRAS mutation. Women with advanced stage LGSC and residual disease following debulking surgery had a similarly poor progression-free and overall-survival compared with HGSC patients. We saw a dramatic response to BRAF inhibition in a patient with BRAFV600E-positive LGSC, however, the LGSC cell lines did not respond to dabrafenib. This is not surprising as the cell lines did not harbour the hot-spot BRAFV600E mutation. MPSC1 has a BRAFV600L and a NRASQ16R mutation, but dabrafenib did not inhibit growth. HCC5075 (KRASG12V) was sensitive to all three MEK inhibitors, but response to MEK inhibition in the other LGSC cell lines was modest. In conclusion, LGSC are generally chemotherapy resistant and molecular analyses can identify targetable mutations. However, LGSC are heterogenous with respect to underlying mutations and response to pathway inhibitors is likely to depend on which mutations and pathways are activated. BRAF mutations are not uncommon in patients with LGSC and should be routinely tested as BRAF inhibitors can be an effective treatment for these patients. MEK inhibitors may also be effective in a subset of cases. The results highlight the need for novel clinical trial design, as traditional clinical trials are unlikely to be effective in rare ovarian cancer sub-types. Citation Format: Tania Moujaber, Dariush Etemadmoghadam, Cristina Mapagu, Catherine Kennedy, Yoke-Eng Chiew, Casina Kan, Nikilyn Nevins, Sivatharsny Srirangan, Sian Fereday, Nadia Traficante, Australian Ovarian Cancer Study group, David Bowtell, Rosemary Balleine, Paul Harnett, Anna deFazio. Mutations in low-grade serous ovarian cancer and response to BRAF and MEK inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2584.