Investigating developmental delay in South Africa: A pragmatic approach

Global developmental delay and intellectual disability are common disorders in every population, with a prevalence of 1 - 5%. Although a specific cause is not always immediately identifiable, for many affected people the aetiology is genetic or the result of secondary insult to the developing brain. Investigating children with intellectual developmental disorders (IDD) may be a significant challenge, especially in resource-limited settings. Comprehensive clinical evaluation is the first step and frequently determines the direction of further investigations. Hearing and vision screening and thyroid function tests should be performed in most patients. Children with neurological findings should undergo brain imaging, and careful consideration should be given to potential metabolic disorders in all children with IDD, a number of whom are amenable to treatment. Most children in whom a specific direction is not suggested after history-taking and examination, should be tested for chromosomal abnormalities, ideally with chromosomal microarray, which has a diagnostic detection rate of 8 - 20% in IDD. Additional tests may be indicated in particular settings, including broad-based testing for single-gene disorders, such as next-generation sequencing gene panels or exome analysis. All genetic testing has the potential of finding variants of uncertain significance, particularly when there are limited population data, such as in Africa. Making a specific diagnosis in IDD is of benefit to patients, their families and society. Therefore, a rational approach to investigating this group of patients is essential to maximise the health benefit in a cost-effective way

In vivo construction of recombinant molecules within the Caenorhabditis elegans germ line using short regions of terminal homology

Homologous recombination provides a means for the in vivo construction of recombinant DNA molecules that may be problematic to assemble in vitro. We have investigated the efficiency of recombination within the Caenorhabditis elegans germ line as a function of the length of homology between recombining molecules. Our findings indicate that recombination can occur between molecules that share only 10 bp of terminal homology, and that 25 bp is sufficient to mediate relatively high levels of recombination. Recombination occurs with lower efficiency when the location of the homologous segment is subterminal or internal. As in yeast, recombination can also be mediated by either single- or double-stranded bridging oligonucleotides. We find that ligation between cohesive ends is highly efficient and does not require that the ends be phosphorylated; furthermore, precise intermolecular ligation between injected molecules that have blunt ends can also occur within the germ line

The Experiences of Counselors-in-Training in a School-based Counseling Practicum

Counselor education programs often must choose between providing in vivo faculty supervision or a community-based setting. Programs that combine both elements have shown positive preliminary findings related to counselor development; however, the in-depth experiences of students in such programs have not been explored. This phenomenological study examined the lived experiences of counselors-in-training who participated in a school-based counseling practicum with in vivo faculty supervision. Researchers identified six themes, including continuum of support within relationships, operational challenges and concerns, needs and challenges of the community, working with children, expectations and realities, and counselor identity development. Implications for counselor education and research are provided

The Experiences of Counselors-in-Training in a School-based Counseling Practicum

Counselor education programs often must choose between providing in vivo faculty supervision or a community-based setting. Programs that combine both elements have shown positive preliminary findings related to counselor development; however, the in-depth experiences of students in such programs have not been explored. This phenomenological study examined the lived experiences of counselors-in-training who participated in a school-based counseling practicum with in vivo faculty supervision. Researchers identified six themes, including continuum of support within relationships, operational challenges and concerns, needs and challenges of the community, working with children, expectations and realities, and counselor identity development. Implications for counselor education and research are provided

Magnesium Excretion in C. elegans Requires the Activity of the GTL-2 TRPM Channel

Systemic magnesium homeostasis in mammals is primarily governed by the activities of the TRPM6 and TRPM7 cation channels, which mediate both uptake by the intestinal epithelial cells and reabsorption by the distal convoluted tubule cells in the kidney. In the nematode, C. elegans, intestinal magnesium uptake is dependent on the activities of the TRPM channel proteins, GON-2 and GTL-1. In this paper we provide evidence that another member of the TRPM protein family, GTL-2, acts within the C. elegans excretory cell to mediate the excretion of excess magnesium. Thus, the activity of GTL-2 balances the activities of the paralogous TRPM channel proteins, GON-2 and GTL-1

The geographies of food banks in the meantime

The authors gratefully acknowledge the support given by the British Academy for this research (grant no. SG131950). The ‘Emergency Food Provision in the UK’ research includes: over eighteen months of ethnographic research in a Trussell Trust Foodbank; a national survey of the Trussell Trust Network and Independent food banks (and other food aid providers); and in-depth interviews with food bank managers, volunteers and service-users in London, Bristol, Leicestershire, South Wales, Devon, and Cornwall

Cytokine/chemokine profiles in squamous cell carcinoma correlate with precancerous and cancerous disease stage.

Actinic Keratosis (AK), Intraepidermal Carcinoma (IEC), and Squamous Cell Carcinoma (SCC) are generally considered to be advancing stages of the same disease spectrum. However, while AK often regress spontaneously, and IEC often regress in response to immune-activating treatments, SCC typically do not regress. Therefore, it is vital to define whether fundamental immunological changes occur during progression to SCC. Here we show that proinflammatory cytokine expression, chemokine expression, and immune cell infiltration density change during progression to SCC. Our findings suggest a switch from predominantly proinflammatory cytokine production to chemokine production is a key feature of progression from precancer to cancer. Together, these observations propose a model that can underpin current research and open new avenues of exploration into the clinical significance of these profiles with respect to immunotherapeutic or other treatment outcomes

Catheter event rates in medical compared to surgical peritoneal dialysis catheter insertion

Introduction: How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways. Methods: We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality. Results: Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96). Conclusion: Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer

Attitudes towards Peritoneal Dialysis among Peritoneal Dialysis and Hemodialysis Medical Directors: Are we preaching to the right choir?

Research letter

A very conscientious brand: A case study of the BBC's current affairs series Panorama

The reputation of British current affairs and documentary series such as the BBC's Panorama, Channel 4’s Dispatches or the now defunct Granada series World in Action have rested on an image of conscientious ‘public service’. These popular, long running series have, at various points in their history, acted as the ‘conscience of the nation’, seeking to expose social injustice, investigate misdemeanours by the powerful and take on venal or corrupt vested interest. The BBC’s flagship current affairs series Panorama is Britain’s longest running television programme and, according to the Panorama website, ‘the world’s longest running investigative TV show’. It has provided a template for other current affairs series both in Britain, Europe and around the world while undergoing several transformations in form and style since its launch in 1953, the latest and arguably most dramatic being in 2007. This article will chart the development of Panorama as a distinctive, ‘flagship' current affairs series over six decades. It will attempt to answer why the Panorama brand has survived so long, while so many other notable current affairs series have not. Using research and material from Bournemouth University’s Panorama Archive, the Video Active website, the BFI and other European archives this article explores the development of an iconic current affairs series that has, at different stages in its history, proved a template for other news and current affairs programmes. Various breaks and continuities are highlighted in Panorama’s history and identity, and an attempt will be made to characterise and specify the Panorama ‘brand’ and pinpoint the series’ successes and failures in reinventing itself in a rapidly changing media context