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Background: Tics are conceptualized as a sensorimotor phenomenon with a premonitory urge typically described by patients. As observed in other neurodevelopmental disorders, we have observed sensory dysregulation symptoms, such as tactile hypersensitivity to clothing, in children with tic disorders; however, formal clinical research in this area is limited.Objective: To define the presence of sensory dysregulation symptoms in tic disorders, and their clinical associations.Methods: Prevalence of sensory dysregulation in 102 children with tic disorders was compared to 61 age- and sex-matched healthy controls. Sensory dysregulation, executive function, and quality of life data were obtained through the Short Sensory Profile-2, Sensory Profile-2, Sensory Processing Measure, Behaviour Rating Inventory of Executive Function-2, and Strength and Difficulties Questionnaire and Pediatric Quality of Life Inventory. Tics were assessed with the Yale Global Tic Severity Scale.Results: Children with tics, in the presence of comorbidity, had elevated sensory dysregulation compared to healthy controls (P < 0.001). There was a positive correlation between sensory dysregulation and global executive difficulties in children with tics and comorbidity (n = 87; rho = 0.716; P < 0.001) and a negative correlation of sensory dysregulation with quality of life (n = 87; rho = -0.595; P < 0.001). In children with tics, there was an association between sensory dysregulation and number of comorbidities (P < 0.001).Conclusion: In the presence of comorbidity, children with tic disorders have broad sensory dysregulation symptoms beyond the premonitory urge. There was a statistically significant association between sensory dysregulation and executive function difficulties and the presence of neurodevelopmental and psychiatric comorbidity. Sensory dysregulation can be considered neurodevelopmental symptoms, providing insight into the neurobiology of tics and opportunities for therapeutic intervention. © 2019 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Objectives: This preliminary study explored whether an adapted approach to the Alert Program, that uses sensorimotor strategies, might assist with management of tic disorders in children. The Alert Program, a program that uses sensorimotor strategies for self-regulation in children with neurodevelopmental disorders, had not been trialled with children with tic disorders.Methods: Ten children with tic disorder were assessed using the Dunn Sensory Profile 2 (SP2), the Yale Global Tic Severity Scale (YGTSS) and the Parent Tic Questionnaire (PTQ). Participants attended three 60-90-minute appointments with an occupational therapist and clinical psychologist for implementation of the adapted Alert Program.Results: The YGTSS showed tic reduction in all participants. The total YGTSS pre-intervention mean score of 46.5 improved to 17.7 post-therapy. Five participants reported no impairment post-therapy. PTQ scores reduced in nine participants. On the SP2, 30% of participants scored as having sensory sensitivities that impaired daily function.Conclusions: This exploratory study found trialling an adapted approach to the Alert Program that uses sensorimotor-based approach decreased tic severity in children with tic disorders. A randomised controlled trial is needed to establish the effectiveness and feasibility of this approach. [ABSTRACT FROM AUTHOR]

Abstract: When adding substances to the wheel–rail contact, they mix with wear particles and form a Third Body Layer (3BL). This layer influences the initial gradient of the traction characteristic. During twin-disc tests presented in this paper, a granular layer consisting of iron and iron oxides with a thickness of up to was found. In addition, a creepforce model is presented that uses non-linear properties of the 3BL to describe its influence on the traction characteristic. The results of the model were compared to the results of the experiment. A qualitative and quantitative agreement was achieved. This will improve, e.g., the quality of vehicle dynamics simulations, optimizations of control devices for traction and braking, and predictions of wear and damage on wheel and rail. [Copyright &y& Elsevier]

In the UK, the Department of Health's Research Governance Framework for Health and Social Care (RGF) (DOH, 2001) requires that an independent ethical review is undertaken for all health and social work research. It is in the process of consulting and developing systems for appropriate social work ethical review that is comparable to those in existence within Britain's health sector. This article's purpose is to advance current debates by examining these ethical review initiatives and by so doing, facilitate a broader understanding of what is specific to social work research both within and beyond the UK. It is hoped this will strengthen and help legitimise understanding of its nature during the search for research excellence. It is suggested that situation ethics may provide a useful framework for approaching ethical review as it places an emphasis on the unique situation surrounding any given moral choice facing an individual at a particular time. [ABSTRACT FROM AUTHOR]

The concept of managing and adjustment of friction between the wheel and rail has a long history within the operation of railways systems. In the past, adjustment/management has been limited to gauge face lubrication and the use of sanding equipment. The introduction of the top of rail (TOR) friction modifier (FM) over the last 20 years now allows for the modification of the friction at the top of rail–wheel tread interface. This paper focusses on the concept of TOR friction adjustment. Recent developments have led to a new generation of products, defined here as, TOR lubricants (oil and/or grease-based) and hybrid materials (oil/water mixtures), which are non-drying or slow drying. Definitions and functional difference are detailed and contrasted with that of the water-based drying FM. The water-based TOR-FM once applied rapidly dries, mixes with the existing third-body layer, and allows for the accommodation of shear displacement. TOR lubricants and hybrid materials rely on mixed boundary layer lubrication, contrary to application of the water-based TOR-FM. It has been shown that the adhesion level is highly influenced by the lubricant application rates. The risks and benefits (lateral force reduction, corrugation mitigation, and impact on energy consumption and influence on rolling contact fatigue) are discussed for all product classifications. However, a lack of data exists for the TOR lubricants especially in the area of rolling contact fatigue where laboratory studies have identified the possibility of crack interaction. Whilst it can be seen that TOR lubricants have the ability to provide similar benefits to that of a water-based FM, they exhibit a strong dependency on the application rate which may lend itself to adhesion and RCF issues. Further work is recommended in this area. [ABSTRACT FROM AUTHOR]

• Autoimmune disease is more frequent in mothers of children with tics/OCD. • Maternal inflammatory states are generally associated with childhood tics/OCD. • Maternal blood and Tourette brain transcriptomes show common innate immune pathways. • Inflammation may be an important environmental modifier in tic/OCD expression. • Targeting inflammation may mitigate risk and improve treatment of tics/OCD. Although genetic variation is a major risk factor of neurodevelopmental disorders, environmental factors during pregnancy and early life are also important in disease expression. Animal models demonstrate that maternal inflammation causes fetal neuroinflammation and neurodevelopmental deficits, and brain transcriptomics of neurodevelopmental disorders in humans show upregulated differentially expressed genes are enriched in immune pathways. We prospectively recruited 200 sequentially referred children with tic disorders/obsessive–compulsive disorder (OCD), 100 autoimmune neurological controls, and 100 age-matched healthy controls. A structured interview captured the maternal and family history of autoimmune disease and other pro-inflammatory states. Maternal blood and published Tourette brain transcriptomes were analysed for overlapping enriched pathways. Mothers of children with tics/OCD had a higher rate of autoimmune disease compared with mothers of children with autoimmune neurological conditions (p = 0.054), and mothers of healthy controls (p = 0.0004). Autoimmunity was similarly elevated in first- and second-degree maternal relatives of children with tics/OCD (p < 0.0001 and p = 0.014 respectively). Other pro-inflammatory states were also more common in mothers of children with tics/OCD than controls (p < 0.0001). Upregulated differentially expressed genes in maternal autoimmune disease and Tourette brain transcriptomes were commonly enriched in innate immune processes. Pro-inflammatory states, including autoimmune disease, are more common in the mothers and families of children with tics/OCD. Exploratory transcriptome analysis indicates innate immune signalling may link maternal inflammation and childhood tics/OCD. Targeting inflammation may represent preventative strategies in pregnancy and treatment opportunities for children with neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

This paper presents direct track deflection data measured using a video gauge (VG) (a digital image correlation (DIC) method) to determine track stiffness characteristics remotely. Two cases are discussed. First, the deflection performance of two novel ballastless trackforms are coupled with an analytical model to assess their stiffness properties for known train loads. Second, the performance of a bridge transition is evaluated under live train passages by the VG; the traffic loads are assumed based on train type to allow track stiffness interpretation from a number of train passes. A track deflection bowl is assessed to show the performance of the transition. The paper initially discusses the DIC technique and the importance and assessment of track stiffness. It then presents the VG deflection data, the global support stiffnesses and deflection bowls. These novel methods are shown to be consistent with other approaches of track stiffness evaluation. The paper concludes with a discussion of how this methodology can be utilised in the railway industry for assessing the trackbed performance of critical zones without the need for track possessions. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of transobturator tapes in the treatment of women with recurrent urodynamic stress incontinence. Methods: We performed a secondary analysis of a prospective, randomized, single-blinded study. A total of 341 women were recruited (April 2005 and April 2007) and randomly assigned to undergo “inside-out” TVT-O or “outside-in” TOT-ARIS. Of these women, 46 had undergone ≥1 previous continence procedures and were included in the present study. The preoperative assessment included a urodynamic assessment and completion of validated symptom severity and quality-of-life questionnaires. The primary outcome was the patient-reported success rate at 1 year as assessed using the Patient Global Impression of Improvement (very much/much improved). The secondary outcomes included changes in quality of life, sexual function, the objective success rates defined as negative findings on the standard 1-hour pad test, and a comparison between both routes of transobturator tapes. Multivariate analysis was performed to identify the risk factors for failure. Results: All 46 women completed the 1-year follow-up period. The patient-reported success rate and objective cure rate was 69.6% and 76.5%, respectively, with no significant differences between the 2 transobturator routes (P = .104, odds ratio [OR] 2.933, 95% confidence interval [CI] 0.803-10.719; and P = .077, OR 4.524, 95% CI 0.849-24.109, respectively). Of the 46 women, 35 (76.1%) reported >10-point improvement on the total King''s Health Questionnaire scores and 71% of sexually active women (n = 22) showed an improvement in the total 12-item Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire scores. On multivariate analysis, a maximal urethral closure pressure of <30 cm H2O was the only independent risk factor for failure (P = .016, OR 9.206, 95% CI 1.511-56.104). Conclusions: Transobturator tapes have good patient-reported and objective success rates at 1 year of follow-up in women with previous failed incontinence surgery. A low maximal urethral closure pressure was the only independent predictor of failure. [Copyright &y& Elsevier]

Abstract: Objectives: To compare the “inside-out (TVT-O)” vs. “outside-in (ARIS)” transobturator tapes in the management of female urodynamic stress incontinence (USI) and to identify independent risk factors of failure of transobturator tapes. Study design: A prospective, single blinded, randomised trial. Women undergoing transobturator tapes as sole procedure in the period April 2005 and April 2007 were randomised to TVT-O™ for the inside-out approach and TOT–ARIS for the outside-in approach. The primary outcome measure at 6 months was the absence of USI on urodynamics. Secondary outcomes included; patient-reported success rates, overall patient satisfaction and peri-operative complications. Results: 341 women were recruited: 171 in the outside-in group and 170 in the inside-out. Severe post-operative thigh pain was twice as common in the inside-out group but this was not statistically significant (6.7% vs. 3.5%, p =0.19). 317 women completed the 6 months follow-up; objective cure rates and patient-reported success rates were 85.4 and 80.5%, respectively, with no significant difference between the groups (p =0.28 and p =0.138, respectively). On multivariate analysis: low maximum urethral closure pressure (MUCP) (<30cm H2O) and previous incontinence surgery were confirmed as independent risk factors for objective failure of transobturator tape with increased odds of failure of 7.06 (2.85–17.48) and 6.22 (2.34–16.52), respectively. Conclusion: This study shows no significant differences in the objective cure rates and patient-reported success rates between the “inside-out (TVT-O™)” and “outside-in (ARIS)” transobturator tape procedures in the management of female USI at 6 months follow-up. Previous incontinence surgery and low MUCP were significant risk factors for failure of transobturator tapes. [Copyright &y& Elsevier]