Maternity care and 'Every Child Matters'

The first part of the chapter will provide an introduction to maternity services in the UK and why it is the foundation of ‘Every Child Matters’. It is the earliest healthcare intervention of all for the child and it is essential to get it right for babies and parents. The role of the key professionals involved with care provision will be explained as they may be unfamiliar to some readers. By using case studies as examples, the chapter will then explore how each of them contributes to addressing the key recommendations of Every Child Matters including the Common Assessment framework (CAF) and the strategic challenges of the Children’s Workforce. The final part of the chapter will focus on discussing future trends in maternity care with relation to Every Child Matters

Multi-Modal Delivery Approaches in Teaching Postgraduate Legal Research Courses

This paper commences with a consideration of the rationales for teaching legal research to postgraduate students. It discusses the importance of legal research to the dynamic and ever-changing discipline of law and the added significance of this area to postgraduate study. The paper then discusses the learning needs of postgraduate students and the changing educational environment that they face, and how new directions in education and developments in student numbers and background, funding and technology affect this environment. It examines the contextual needs of postgraduate students and how these affect their expectations of postgraduate study. The paper concludes with an analysis of the results of a survey of students undertaking the subject Advanced Legal Research as to various modes of delivery and considers some recommendations arising from the responses

Tackling unemployment, supporting business and developing careers

The issue of unemployment remains high on the political agenda. However, there is evidence that employers can be wary of employing people who are out of work. Employer practice is key, both in terms of providing employment opportunities to job seekers, and in providing space for low-skilled people to develop their skills and cement their attachment to the labour market. This report discusses the role of career guidance in mediating between job seekers and employers to allow both to achieve their objectives.The issue of unemployment remains high on the political agenda. However, there is evidence that employers can be wary of employing people who are out of work. Employer practice is key, both in terms of providing employment opportunities to job seekers, and in providing space for low-skilled people to develop their skills and cement their attachment to the labour market. This report discusses the role of career guidance in mediating between job seekers and employers to allow both to achieve their objectives

Cultural considerations at end of life in a geriatric inpatient rehabilitiation setting

Aim: To explore the impact of cultural factors on the provision of end-of-life care in a geriatric inpatient rehabilitation setting. Background: Australia’s ageing population is now also one of the most culturally diverse. Individuals from culturally and linguistically diverse backgrounds may have specific care needs at the end of life according to various aspects of their culture. Design: A mixed method approach using a retrospective audit of existing hospital databases, deceased patients’ medical records, and in-depth interviews with clinicians. Findings: Patients’ and families’ cultural needs were not always recognised or facilitated in end-of-life care, resulting in missed opportunities to tailor care to the individual’s needs. Clinicians identified a lack of awareness of cultural factors, and how these may influence end-of-life care needs. Clinicians expressed a desire for education opportunities to improve their understanding of how to provide patient-specific, culturally sensitive end-of-life care. Conclusion: The findings highlight that dying in geriatric inpatient rehabilitation settings remains problematic, particularly when issues of cultural diversity further compound end-of-life care provision. There is a need for recognition and acceptance of the potential sensitivities associated with cultural diversity and how it may influence patients’ and families’ needs at the end of life. Health service organisations should prioritise and make explicit the importance of early referral and utilisation of existing support services such as professional interpreters, specialist palliative care and pastoral care personnel in the provision of end-of-life care. Furthermore, health service organisations should consider reviewing end-of-life care policy documents, guidelines and care pathways to ensure there is an emphasis on respecting and honouring cultural diversity at end of life. If use of a dying care pathway for all dying patients was promoted, or possibly mandated, these issues would likely be addressed. © 2018 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd

“The First Day He Kicked Shoes at Me, the Last Day He Brought Me a Picture of Himself”: Investigating the Practicum Experiences of Pre-service Teachers

The purpose of this study was to describe the ways in which the experiences gained during practica influence the developing self-efficacy of Canadian pre-service teachers for teaching in inclusive classrooms. Questionnaires were issued to participants in teacher education programs at 11 universities across Canada, and the data were subjected to content analysis. Several themes that emerged from the participant responses were found to be influential in pre-service teachers’ feelings of efficacy, with behaviour management having the greatest influence, regardless of whether participants felt successful or challenged. Academic outcomes, relationships with students, and other school adults as resources were also identified as themes influencing pre-service teachers’ feelings of success and challenge in practica. The data revealed attitudes and beliefs about inclusion and the impact these may have on teacher efficacy. Several elements can positively influence teacher efficacy including the ability to identify and utilize instructional and personnel resources, the ability to form supportive professional relationships with other school adults, and the ability to recognize achievement as it pertains to the individual rather than prescribed norms. As beliefs about self-efficacy are informed by enactive mastery experiences, vicarious experiences, physiological factors, and verbal persuasion, teacher preparation programs can foster teacher efficacy by encouraging the development of positive attitudes and equipping teachers with the skills they need

Ectopic intralaryngo-tracheal thyroid tissue causing neonatal death

Introduction: Ectopic thyroid tissue can be found anywhere along the embryologic path of thyroid descent. Intralaryngo-tracheal thyroid tissue is the least common site of ectopia and can present with upper airways obstruction. Its presentation in the neonate is exceptional. Case Report: We describe a term female neonate with subglottic thyroid tissue causing near-total occlusion of the larynx, which led to upper airways obstruction and neonatal death. Conclusion: This emphasizes the importance of considering intralaryngo-tracheal tumors as a cause of acute and otherwise unexplainable respiratory distress immediately after birth. The cause of this neonatal death would not have been elucidated without careful autopsy examination

Age-Related Sexual Dimorphism in Temporal Discrimination and in Adult-Onset Dystonia Suggests GABAergic Mechanisms

Background: Adult-onset isolated focal dystonia (AOIFD) presenting in early adult life is more frequent in men, whereas in middle age it is female predominant. Temporal discrimination, an endophenotype of adult-onset idiopathic isolated focal dystonia, shows evidence of sexual dimorphism in healthy participants. Objectives: We assessed the distinctive features of age-related sexual dimorphism of (i) sex ratios in dystonia phenotypes and (ii) sexual dimorphism in temporal discrimination in unaffected relatives of cervical dystonia patients. Methods: We performed (i) a meta-regression analysis of the proportion of men in published cohorts of phenotypes of adult-onset dystonia in relation to their mean age of onset and (ii) an analysis of temporal discrimination thresholds in 220 unaffected first-degree relatives (125 women) of cervical dystonia patients. Results: In 53 studies of dystonia phenotypes, the proportion of men showed a highly significant negative association with mean age of onset (p \u3c 0.0001, pseudo-R2 = 59.6%), with increasing female predominance from 40 years of age. Age of onset and phenotype together explained 92.8% of the variance in proportion of men. Temporal discrimination in relatives under the age of 35 years is faster in women than men but the age-related rate of deterioration in women is twice that of men; after 45 years of age, men have faster temporal discrimination than women. Conclusion: Temporal discrimination in unaffected relatives of cervical dystonia patients and sex ratios in adult-onset dystonia phenotypes show similar patterns of age-related sexual dimorphism. Such age-related sexual dimorphism in temporal discrimination and adult-onset focal dystonia may reflect common underlying mechanisms. Cerebral GABA levels have been reported to show similar age-related sexual dimorphism in healthy participants and may be the mechanism underlying the observed age-related sexual dimorphism in temporal discrimination and the sex ratios in AOIFD

Survival Trends After Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period.

OBJECTIVE: We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDHs) in England and Wales over a 20-year period. SUMMARY OF BACKGROUND DATA: ASDHs are still considered the most lethal type of traumatic brain injury. It remains unclear whether the adjusted odds of survival have improved significantly over time. METHODS: Using the Trauma Audit and Research Network (TARN) database, we analyzed ASDH cases in the adult population (>16 yrs) treated surgically between 1994 and 2013. Two thousand four hundred ninety-eight eligible cases were identified. Univariable and multiple logistic regression analyses were performed, using multiple imputation for missing data. RESULTS: The cohort was 74% male with a median age of 48.9 years. Over half of patients were comatose at presentation (53%). Mechanism of injury was due to a fall (2 m 24%), road traffic collision (25%), and other (17%). Thirty-six per cent of patients presented with polytrauma. Gross survival increased from 59% in 1994 to 1998 to 73% in 2009 to 2013. Under multivariable analysis, variables independently associated with survival were year of injury, Glasgow Coma Scale, Injury Severity Score, age, and pupil reactivity. The time interval from injury to craniotomy and direct admission to a neurosurgical unit were not found to be significant prognostic factors. CONCLUSIONS: A significant improvement in survival over the last 20 years was observed after controlling for multiple prognostic factors. Prospective trials and cohort studies are expected to elucidate the distribution of functional outcome in survivors.AGK is supported by a Royal College of Surgeons of England Research Fellowship, a National Institute for Health Research (NIHR) Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. PJH is supported by a NIHR Research Professorship and the NIHR Cambridge Biomedical Research Centre.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wolters Kluwer

Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South

Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. / Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. / Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. / Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. / Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). / Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally