Understanding the impact of trauma on executive function in care experienced children: neurodevelopment, staff training and attributions

Background Children who are cared for away from their biological families represent a highly vulnerable population where early childhood trauma, abuse, and neglect are highly prevalent. As technology and theory have advanced it has now been recognised that traumatic experiences in early life can lead to a variety of neurodevelopmental differences, deficits, and delays. Importantly, executive function - a set of cognitive abilities which allow individuals to plan, monitor and adjust their behaviour in order to interact with their environment effectively - has been shown to be particularly sensitive to the impact of traumatic experiences in youth. The core skills in executive function are recognised as cognitive flexibility, working memory, and inhibitory control, skills which have been evidenced to be significantly reduced in children and young people in care, even in comparison with other traumatised youth. However, the specific mechanisms and variables which influence this vulnerability for children within the care system have yet to be understood. Aims This thesis therefore aims to explore the combined impact of trauma and experience of alternative care on the development of executive function. This will include a systematic review of the evidence around executive function difficulties in children in alternative care, and two empirical articles, looking at the impact of an online training course for residential childcare workers which is focussed on the developmental impact of trauma on the executive function of children in care and how this can be supported. The two papers present the acceptability and feasibility of the course, as well as the effect of the course on knowledge gain and the attributions of staff towards challenging behaviour. Methods In Chapter One, a systematic search for papers relating to the executive function of children in care who have experienced trauma was conducted across eight bibliographic databases. Sixteen papers were quality assessed and their results were synthesised in a narrative format. Chapters Two, and Three, describe the development and evaluation of an online training course in executive function for residential workers working with children in care. In Chapter Two, the course is evaluated for acceptability, feasibility and its impact on knowledge gain. In Chapter Three, the course is evaluated for its impact on the attributions of residential childcare workers towards challenging behaviour. Results It was not possible to draw definitive conclusions from the systematic review due to heterogeneity in the papers included. However, the overall direction of results, indicate that children within the care system are not only highly vulnerable to executive functioning difficulties due to their early experiences, but that their specific experiences within the care system may further impact upon the development of these skills. The empirical papers demonstrated that online training around the neurodevelopmental impact of trauma on executive function was feasible and acceptable to residential support workers. The course significantly increased knowledge of executive function after completion and altered staff attributions towards challenging behaviour, by significantly reducing perceptions that the causes of challenging behaviour are internal to the child and within their control, and significantly increasing perceptions that the causes are global and stable across the child’s life. Implications for clinical practice, future training, and ongoing research are discussed

Simulating the coronal evolution of bipolar active regions to investigate the formation of flux ropes

Funding: S.L.Y. would like to acknowledge STFC for support via the Consolidated Grant SMC1/YST025. D.H.M. would like to thank STFC, the Leverhulme Trust and the ERC under the Synergy Grant: The Whole Sun, grant agreement no. 810218 for financial support. L.M.G. is thankful to the Royal Society for a University Research Fellowship and the Leverhulme Trust.The coronal magnetic field evolution of 20 bipolar active regions (ARs) is simulated from their emergence to decay using the time-dependent nonlinear force-free field method of Mackay, Green, and van Ballegooijen (Astrophys. J. 729, 97, 2011). A time sequence of cleaned photospheric line-of-sight magnetograms, which covers the entire evolution of each AR, is used to drive the simulation. A comparison of the simulated coronal magnetic field with the 171 and 193 Å observations obtained by the Solar Dynamics Observatory (SDO)/Atmospheric Imaging Assembly (AIA), is made for each AR by manual inspection. The results show that it is possible to reproduce the evolution of the main coronal features such as small- and large-scale coronal loops, filaments and sheared structures for 80% of the ARs. Varying the boundary and initial conditions, along with the addition of physical effects such as Ohmic diffusion, hyperdiffusion and a horizontal magnetic field injection at the photosphere, improves the match between the observations and simulated coronal evolution by 20%. The simulations were able to reproduce the build-up to eruption for 50% of the observed eruptions associated with the ARs. The mean unsigned time difference between the eruptions occurring in the observations compared to the time of eruption onset in the simulations was found to be ≈5 hrs. The simulations were particularly successful in capturing the build-up to eruption for all four eruptions that originated from the internal polarity inversion line of the ARs. The technique was less successful in reproducing the onset of eruptions that originated from the periphery of ARs and large-scale coronal structures. For these cases global, rather than local, nonlinear force-free field models must be used. While the technique has shown some success, eruptions that occur in quick succession are difficult to reproduce by this method and future iterations of the model need to address this.Publisher PDFPeer reviewe

Determining the source and eruption dynamics of a stealth CME using NLFFF modelling and MHD simulations

Funding: S.L.Y. would like to acknowledge STFC for support via the consolidated grant SMC1/YST037 and alsoNERC for funding via the SWIMMR Aviation Risk Modelling (SWARM) Project, grant number NE/V002899/1. P.P.would like to thank the ERC for support via grant No. 647214. D.H.M. would like to thank the STFC for support via consolidated grant ST/N000609/1 and, the Leverhulme trust, and the ERC under the Synergy Grant: The Whole Sun (grant agreement no. 810218) for financial support. P.P. and D.H.M. would like to thank STFC for IAA funding under grant number SMC1-XAS012. L.A.U. was supported by the NSF Atmospheric and Geospace Sciences Postdoctoral Research Fellowship Program (Award AGS-1624438).Context. Coronal mass ejections (CMEs) that exhibit weak or no eruption signatures in the low corona, known as stealth CMEs, are problematic as upon arrival at Earth they can lead to geomagnetic disturbances that were not predicted by space weather forecasters. Aims. We investigate the origin and eruption of a stealth event that occurred on 2015 January 3 that was responsible for a strong geomagnetic storm upon its arrival at Earth. Methods. To simulate the coronal magnetic field and plasma parameters of the eruption we use a coupled approach. This approach combines an evolutionary nonlinear force-free field model of the global corona with a MHD simulation. Results. The combined simulation approach accurately reproduces the stealth event and suggests that sympathetic eruptions occur. In the combined simulation we found that three flux ropes form and then erupt. The first two flux ropes, which are connected to a large AR complex behind the east limb, erupt first producing two near-simultaneous CMEs. These CMEs are closely followed by a third, weaker flux rope eruption in the simulation that originated between the periphery of AR 12252 and the southern polar coronal hole. The third eruption coincides with a faint coronal dimming, which appears in the SDO/AIA 211 Å observations, that is attributed as the source responsible for the stealth event and later the geomagnetic disturbance at 1 AU. The incorrect interpretation of the stealth event being linked to the occurrence of a single partial halo CME observed by LASCO/C2 is mainly due to the lack of STEREO observations being available at the time of the CMEs. The simulation also shows that the LASCO CME is not a single event but rather two near-simultaneous CMEs. Conclusions. These results show the significance of the coupled data-driven simulation approach in interpreting the eruption and that an operational L5 mission is crucial for space weather forecastingPostprintPeer reviewe

Delivering sustained, coordinated and integrated observations of the Southern Ocean for global impact

The Southern Ocean is disproportionately important in its effect on the Earth system, impacting climatic, biogeochemical, and ecological systems, which makes recent observed changes to this system cause for global concern. The enhanced understanding and improvements in predictive skill needed for understanding and projecting future states of the Southern Ocean require sustained observations. Over the last decade, the Southern Ocean Observing System (SOOS) has established networks for enhancing regional coordination and research community groups to advance development of observing system capabilities. These networks support delivery of the SOOS 20-year vision, which is to develop a circumpolar system that ensures time series of key variables, and delivers the greatest impact from data to all key end-users. Although the Southern Ocean remains one of the least-observed ocean regions, enhanced international coordination and advances in autonomous platforms have resulted in progress toward sustained observations of this region. Since 2009, the Southern Ocean community has deployed over 5700 observational platforms south of 40°S. Large-scale, multi-year or sustained, multidisciplinary efforts have been supported and are now delivering observations of essential variables at space and time scales that enable assessment of changes being observed in Southern Ocean systems. The improved observational coverage, however, is predominantly for the open ocean, encompasses the summer, consists of primarily physical oceanographic variables, and covers surface to 2000 m. Significant gaps remain in observations of the ice-impacted ocean, the sea ice, depths >2000 m, the air-ocean-ice interface, biogeochemical and biological variables, and for seasons other than summer. Addressing these data gaps in a sustained way requires parallel advances in coordination networks, cyberinfrastructure and data management tools, observational platform and sensor technology, two-way platform interrogation and data-transmission technologies, modeling frameworks, intercalibration experiments, and development of internationally agreed sampling standards and requirements of key variables. This paper presents a community statement on the major scientific and observational progress of the last decade, and importantly, an assessment of key priorities for the coming decade, toward achieving the SOOS vision and delivering essential data to all end-users.Fil: Newman, Louise. University of Tasmania; AustraliaFil: Heil, Petra. Australian Antarctic Division; Australia. Antarctic Climate And Ecosystems Cooperative Research Centre; AustraliaFil: Trebilco, Rowan. Australian Antarctic Division; Australia. Antarctic Climate And Ecosystems Cooperative Research Centre; AustraliaFil: Katsumata, Katsuro. Japan Agency For Marine earth Science And Technology; JapónFil: Constable, Andrew J.. Antarctic Climate And Ecosystems Cooperative Research Centre; Australia. Australian Antarctic Division; AustraliaFil: Wijk, Esmee van. Commonwealth Scientific And Industrial Research Organization; Australia. Antarctic Climate And Ecosystems Cooperative Research Centre; AustraliaFil: Assmann, Karen. University Goteborg; SueciaFil: Beja, Joana. British Oceanographic Data Centre; AustraliaFil: Bricher, Phillippa. University of Tasmania; AustraliaFil: Coleman, Richard. University of Tasmania; AustraliaFil: Costa, Daniel. University of California; Estados UnidosFil: Diggs, Steve. University of California; Estados UnidosFil: Farneti, Riccardo. The Abdus Salam; Italia. The Abdus Salam. International Centre for Theoretical Physics; ItaliaFil: Fawcett, Sarah. University of Cape Town; SudáfricaFil: Gille, Sarah. University of California; Estados UnidosFil: Hendry, Katharine R.. University of Bristol; Reino UnidoFil: Henley, Sian F.. University of Edinburgh; Reino UnidoFil: Hofmann, Eileen. Old Dominion University; Estados UnidosFil: Maksym, Ted. University of California; Estados UnidosFil: Mazloff, Matthew. University of California; Estados UnidosFil: Meijers, Andrew J.. British Antartic Survey; Reino UnidoFil: Meredith, Michael. British Antartic Survey; Reino UnidoFil: Moreau, Sebastien. Norwegian Polar Institute; NoruegaFil: Ozsoy, Burcu. Istanbul Teknik Üniversitesi; TurquíaFil: Robertson, Robin. Xiamen University; ChinaFil: Schloss, Irene Ruth. Universidad Nacional de Tierra del Fuego; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: Schofield, Oscar. State University of New Jersey; Estados UnidosFil: Shi, Jiuxin. Ocean University Of China; ChinaFil: Sikes, Elisabeth L.. State University of New Jersey; Estados UnidosFil: Smith, Inga J.. University of Otago; Nueva Zeland

Quantifying neutralising antibody responses against SARS-CoV-2 in dried blood spots (DBS) and paired sera

The ongoing SARS-CoV-2 pandemic was initially managed by non-pharmaceutical interventions such as diagnostic testing, isolation of positive cases, physical distancing and lockdowns. The advent of vaccines has provided crucial protection against SARS-CoV-2. Neutralising antibody (nAb) responses are a key correlate of protection, and therefore measuring nAb responses is essential for monitoring vaccine efficacy. Fingerstick dried blood spots (DBS) are ideal for use in large-scale sero-surveillance because they are inexpensive, offer the option of self-collection and can be transported and stored at ambient temperatures. Such advantages also make DBS appealing to use in resource-limited settings and in potential future pandemics. In this study, nAb responses in sera, venous blood and fingerstick blood stored on filter paper were measured. Samples were collected from SARS-CoV-2 acutely infected individuals, SARS-CoV-2 convalescent individuals and SARS-CoV-2 vaccinated individuals. Good agreement was observed between the nAb responses measured in eluted DBS and paired sera. Stability of nAb responses was also observed in sera stored on filter paper at room temperature for 28 days. Overall, this study provides support for the use of filter paper as a viable sample collection method to study nAb responses.</p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p