A qualitative evaluation of community nurses’ experiences of child safeguarding supervision

• Safeguarding supervision was viewed as a child-focused, helpful activity that has led to practice improvements. • Negative comments were in the minority and related to perceptions of its intrusive and punitive nature, the time involved and competing priorities. • Improvements advocated were safeguarding supervision should include discussion about children whose care is problematic but who are not the subject to formal child protection proceeding

Semaphorin-6A controls guidance of corticospinal tract axons at multiple choice points

<p>Abstract</p> <p>Background</p> <p>The trajectory of corticospinal tract (CST) axons from cortex to spinal cord involves a succession of choice points, each of which is controlled by multiple guidance molecules. To assess the involvement of transmembrane semaphorins and their plexin receptors in the guidance of CST axons, we have examined this tract in mutants of <it>Semaphorin-6A </it>(<it>Sema6A</it>), <it>Plexin-A2 </it>(<it>PlxnA2</it>) and <it>Plexin-A4 </it>(<it>PlxnA4</it>).</p> <p>Results</p> <p>We describe defects in CST guidance in <it>Sema6A </it>mutants at choice points at the mid-hindbrain boundary (MHB) and in navigation through the pons that dramatically affect how many axons arrive to the hindbrain and spinal cord and result in hypoplasia of the CST. We also observe defects in guidance within the hindbrain where a proportion of axons aberrantly adopt a ventrolateral position and fail to decussate. This function in the hindbrain seems to be mediated by the known Sema6A receptor PlxnA4, which is expressed by CST axons. Guidance at the MHB, however, appears independent of this and of the other known receptor, PlxnA2, and may depend instead on Sema6A expression on CST axons themselves at embryonic stages.</p> <p>Conclusion</p> <p>These data identify Sema6A as a major contributor to the guidance of CST axons at multiple choice points. They highlight the active control of guidance at the MHB and also implicate the inferior olive as an important structure in the guidance of CST axons within the hindbrain. They also suggest that Sema6A, which is strongly expressed by oligodendrocytes, may affect CST regeneration in adults.</p

Outcomes of a teacher-led reading intervention for elementary students at-risk for behavioral disorders

This is the publisher's version, also found here: http://cec.metapress.com/content/g8686u4nu0p8772l/?p=1258705a1fcb41948563bb666b6ae215&pi=2To date, reports of reading interventions for students at risk for emotional/behavioral disorders (E/BD) that have been published in refereed journals have involved sustained support by university or school-site personnel. This study examined the efficacy and feasibility of a reading intervention that 2 general education teachers implemented in inclusive settings to support 7 first-grade students at risk for E/BD and reading difficulties. Results of a multiple baseline design revealed lasting improvements in reading fluency for all students, accompanied by decreases in variability of academic engagement for 4 students. Although intervention goals, procedures, and outcomes exceeded teacher expectations, social validity ratings for some students declined between the onset and the conclusion of the intervention. This article presents limitations, future directions, and educational implications

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Impact of research activity on performance of general practices: a qualitative study

Background: There is evidence that engaging in research is directly associated with better performance. If this relationship is to be strengthened, it is necessary to understand the mechanisms which might underlie that relationship. Aim: To explore the perspectives of staff and wider stakeholders about mechanisms by which research activity might impact on the performance of general practices. Design & Setting: Qualitative study using semi-structured interviews with general practice professionals and wider stakeholders in England. Method: Individual interviews with purposively sampled staff in ‘research ready’ or ‘research active’ general practices and other stakeholders. Interviews were analysed using a Framework approach. Results: Participants described potential ‘direct’ and ‘indirect’ impacts on their work. ‘Direct’ impacts included research changing practice work (e.g. additional records searches for particular conditions), bringing in additional resources (e.g. access to investigations or staff) and improving relationships with patients. ‘Indirect’ impacts included job satisfaction (e.g. perception of practice as a centre of excellence and innovation, and the variety afforded by research activity reducing burnout) and staff recruitment (increasing the attractiveness of the practice as a place to work). Respondents identified few negative impacts. Conclusions: Staff and stakeholders identified a range of potential impacts of research activity on practice performance, with impacts on their working lives most salient. Negative impacts were not generally raised. Nevertheless, respondents generally discussed potential impacts rather than providing specific examples of those impacts. This may reflect the type of research activity conducted in general practice, often led by external collaborators

Mutation of Semaphorin-6A Disrupts Limbic and Cortical Connectivity and Models Neurodevelopmental Psychopathology

Psychiatric disorders such as schizophrenia and autism are characterised by cellular disorganisation and dysconnectivity across the brain and can be caused by mutations in genes that control neurodevelopmental processes. To examine how neurodevelopmental defects can affect brain function and behaviour, we have comprehensively investigated the consequences of mutation of one such gene, Semaphorin-6A, on cellular organisation, axonal projection patterns, behaviour and physiology in mice. These analyses reveal a spectrum of widespread but subtle anatomical defects in Sema6A mutants, notably in limbic and cortical cellular organisation, lamination and connectivity. These mutants display concomitant alterations in the electroencephalogram and hyper-exploratory behaviour, which are characteristic of models of psychosis and reversible by the antipsychotic clozapine. They also show altered social interaction and deficits in object recognition and working memory. Mice with mutations in Sema6A or the interacting genes may thus represent a highly informative model for how neurodevelopmental defects can lead to anatomical dysconnectivity, resulting, either directly or through reactive mechanisms, in dysfunction at the level of neuronal networks with associated behavioural phenotypes of relevance to psychiatric disorders. The biological data presented here also make these genes plausible candidates to explain human linkage findings for schizophrenia and autism

Restoration of self-awareness of hypoglycemia in adults with long-standing type 1 diabetes: hyperinsulinemic-hypoglycemic clamp substudy results from the HypoCOMPaSS trial.

OBJECTIVE: Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. RESEARCH DESIGN AND METHODS: Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 2 × 2 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies. RESULTS: After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420-780] vs. 710 [460-1,260], P = 0.02; metanephrine, 2,412 [-3,026 to 7,279] vs. 5,180 [-771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. CONCLUSIONS: Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance

Identical Genes, Unique Environments: A Qualitative Exploration of Persistent Monozygotic-Twin Discordance in Literacy and Numeracy

This study aimed to explore unique environmental factors impacting differential academic trajectories among Australian school students. Monozygotic (MZ) twin pairs who were consistently discordant in results of nationwide standardized tests of reading, numeracy or writing between Grades 3 and 9 were identified. MZ twins control for genes, gender, age, and aspects of the home and school environment shared by twins. Thus, any difference between MZ twins in academic outcomes can be attributed to the unique environment experienced by each twin. From 551 MZ twin pairs with three or four sets of test results, we identified 55 pairs who were substantially and consistently discordant in reading, numeracy or writing between Grades 3 and 9. Parents were contacted for interview, resulting in 40 semi-structured interviews. Qualitative data analysis revealed three major themes, interpreted by parents as possible contributors to persistent academic discordance: biological mechanisms, school-based factors, and personal factors. We discuss implications for educational practice, policy, and research