How can children aged 8-12 years be involved in decision-making and consent processes in outpatient Child and Adolescent Mental Health Services (CAMHS)? An embedded case study.

Involving children in decision-making and consent processes in their own healthcare has long been a challenging area of clinical practice. The reasons for this are the challenges in assessing child development capabilities in decision-making, and the lack and ambiguity of guidance and frameworks that support this area of practice. This study addresses these challenges in relation to outpatient CAMHS and provides an in-depth examination of how children can consistently be involved in decision-making and consent processes. The study has triangulated children’s, parents’, and clinicians’ perspectives to provide a theoretical understanding of children’s involvement and how this can be used within clinical practice. The method used in this study has been an embedded case study design and the critical realist inquiry of retroduction. A variety of methods and analytical tools transcending the research paradigms have been used to elicit the relevant data. The study includes several literature reviews, a patient clinical record evaluation, a semi-structured questionnaire administered to clinicians, and four focus groups, two with children and two with parents. The findings are i) children can be involved in decision-making and consent processes; ii) children want to be involved in decision-making and consent processes; iii) The onus is on the adults supporting the child in the decision-making process to maximise the child’s involvement in the process and iv) the theories of prioritising, knowing and navigating are fundamental to understanding the decision-making process and provide an evidence base for this area of practice. This study provides practical solutions in translating the theory into practice. In conclusion, decision-making is a multifaceted process that needs time, resources, and skills to facilitate it properly. For the first time, children have been heard in how they want to be involved in decision-making and consent processes. A critical examination of how children can be involved in decision-making and consent processes has been undertaken. The development of the theories of prioritising, knowing, and navigating are critical to fully understanding and implementing this area of practice.Florence Nightingale Foundation (Research Scholarship)Royal College of Nursing Foundation (Research Grant

Authors’ Response: Minimum Confinement Reinforcement for Prestressed Concrete Piles and a Rational Seismic Design Framework

The authors greatly appreciate the reviewer’s interest in “Minimum Confinement Reinforcement for Prestressed Concrete Piles and a Rational Seismic Design Framework,”1 and his useful discussio

Minimum confinement reinforcement for prestressed concrete piles and a rational seismic design framework

The design of prestressed concrete piles in seismic regions is required to include confinement reinforcement in potential plastic hinge regions. However, the existing requirements for quantifying this reinforcement vary significantly, often resulting in unconstructible details. This paper presents a rational approach for designing minimum confinement reinforcement for prestressed concrete piles in seismic regions. By varying key variables, such as the concrete strength, prestressing force, and axial load, the spiral reinforcement quantified according to the proposed approach provides a minimum curvature ductility capacity of about 18, while the resulting ultimate curvature is 28% greater than an estimated target curvature for seismic design. This paper also presents a new axial load limit for prestressed piles, an integrated framework for seismic design of piles and superstructure, the dependency of pile displacement capacity on surrounding soils, and how further reduction to confinement reinforcement could be achieved, especially in medium to soft soils and in moderate to low seismic regions

The clinical value of minimal invasive autopsy in COVID-19 patients

Background Minimally invasive autopsy (MIA) is a validated and safe method to establish the cause of death (COD), mainly in low-resource settings. However, the additional clinical value of MIA in Coronavirus disease (COVID-19) patients in a high-resource setting is unknown. The objective was to assess if and how MIA changed clinical COD and contributing diagnoses in deceased COVID-19 patients. Methods and findings A prospective observational cohort from April to May 2020 in a 981-bed teaching hospital in the epicenter of the COVID-19 pandemic in Belgium was established. Patients who died with either PCR-confirmed or radiologically confirmed COVID-19 infection were consecutively included. MIA consisted of whole-body CT and CT-guided Tru-Cut (R) biopsies. Diagnostic modalities were clinical chart review, radiology, microbiology, and histopathology which were assessed by two independent experts per modality. MIA COD and contributing diagnoses were established during a multi-disciplinary meeting. Clinical COD (CCOD) and contributing diagnosis were abstracted from the discharge letter. The main outcomes were alterations in CCOD and contributing diagnoses after MIA, and the contribution of each diagnostic modality. We included 18 patients, of which 7 after intensive care unit hospitalization. MIA led to an alteration in 15/18 (83%) patients. The CCOD was altered in 5/18 (28%) patients. MIA found a new COD (1/5), a more specific COD (1/5), a less certain COD (1/5), or a contributing diagnosis to be the COD (2/5). Contributing diagnoses were altered in 14/18 (78%) patients: 9 new diagnoses, 5 diagnoses dismissed, 3 made more specific, and 2 made less certain. Overall, histopathology contributed in 14/15 (93%) patients with alterations, radiology and microbiology each in 6/15 (40%), and clinical review in 3/15 (20%). Histopathology was deemed the most important modality in 10 patients, radiology in two patients, and microbiology in one patient. Conclusion MIA, especially histological examination, can add valuable new clinical information regarding the cause of death in COVID-19 patients, even in a high-resource setting with wide access to premortem diagnostic modalities. MIA may provide important clinical insights and should be applied in the current ongoing pandemic

Skunk River Review 2009-10, vol 22

Welcome to the 2009-2010 edition of The Skunk River Review! We received a record number of entries this year, making this volume one of the best and most competitive! We even added a new category called Art & Literary Analysis to include a growing number of submissions dedicated to inspiration and critique. Each year we continue to receive many fine examples of student writing. Selection is a challenging process but enjoyable as the submissions range from a variety of topics and styles. Selected entries were only minimally edited for clarity. The Skunk River Review focuses on students from various DMACC campuses. It includes selections from College Preparatory Writing classes, Composition I and Composition II classes. All entries generally begin as class assignments and are supported by the instructor.https://openspace.dmacc.edu/skunkriver/1001/thumbnail.jp

The Vehicle, 1967, Vol. 9 no. 2

Table of Contents Commentarypage 3 SketchAnn Butlerpage 4 I Take A Long-Out-of-Use BookAnthony Griggspage 5 The Leaf StemDianne Cochranpage 6 The Four MusketeersJim Courterpage 7 Status QuoAdrian Beardpage 7 SketchAnn Butlerpage 8 NocturneMike Baldwinpage 9 Oh Impatient HeartK. H. Shariffpage 9 Letter to a FianceeMaurice Snivelypage 10 Listen!Bonnie Blackpage 11 The Water\u27s EdgeStephen W. Gibbspage 12 TogetherDavid Reifpage 13 SketchAnn Butlerpage 14 Evening TimeSharon Nelsonpage 15 Japanese HaikuBev Hensonpage 15 Of Love and WarBruce Czeluscinskipage 16 Always AloneKib Voorheespage 17 the end of loveJackie Bratcherpage 18 1-20-66Sharon Nelsonpage 19 Blessed Are WeBonnie Marie Beckpage 19 The Time To LiveNeil Tracypage 20 Imminent AwakeningHelen Coxpage 21 The Dead Panther LairMolly J. Evanspage 21 Good SheepMike Tilfordpage 22 The Flame of LifeJacki Jacquespage 23 Then Arrives The Day Of DarkMolly J. Evanspage 23 Sketch: To love is to rememberAnn Butlerpage 24 Hidden RiversCharles J. Mertzpage 25 SilenceLinda G. Phillipspage 26 December - 1964Bonnie Blackpage 26 LoveHazel Thomaspage 27 To Praise A Good Man Neil Tracypage 28 Definitions \u2767Sharon Nelsonpage 29 To Wish Is a CrimeBonnie Marie Beckpage 30 College MadhatterMaurice Snivelypage 31 No. 8Sharon Nelsonpage 32 The Open FireSusan Williamspage 32https://thekeep.eiu.edu/vehicle/1017/thumbnail.jp

Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis.

Multiple sclerosis is a common disease of the central nervous system in which the interplay between inflammatory and neurodegenerative processes typically results in intermittent neurological disturbance followed by progressive accumulation of disability. Epidemiological studies have shown that genetic factors are primarily responsible for the substantially increased frequency of the disease seen in the relatives of affected individuals, and systematic attempts to identify linkage in multiplex families have confirmed that variation within the major histocompatibility complex (MHC) exerts the greatest individual effect on risk. Modestly powered genome-wide association studies (GWAS) have enabled more than 20 additional risk loci to be identified and have shown that multiple variants exerting modest individual effects have a key role in disease susceptibility. Most of the genetic architecture underlying susceptibility to the disease remains to be defined and is anticipated to require the analysis of sample sizes that are beyond the numbers currently available to individual research groups. In a collaborative GWAS involving 9,772 cases of European descent collected by 23 research groups working in 15 different countries, we have replicated almost all of the previously suggested associations and identified at least a further 29 novel susceptibility loci. Within the MHC we have refined the identity of the HLA-DRB1 risk alleles and confirmed that variation in the HLA-A gene underlies the independent protective effect attributable to the class I region. Immunologically relevant genes are significantly overrepresented among those mapping close to the identified loci and particularly implicate T-helper-cell differentiation in the pathogenesis of multiple sclerosis

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy