‘Our Care through our Eyes’: a mixed methods,evaluative study of a service user,co-produced education programme to improve inpatient care of children and young people admitted following self-harm

Introduction: Within Europe, the UK has one of the highest rates of self-harm, with a particularly high prevalence in children and young people (CYP). CYP who are admitted to paediatric hospital wards with self-harm are cared for by registered children's nurses who have been identified to lack specific training in caring for this patient group. This may impede the delivery of high quality care. Therefore, this study aims to co-produce, implement and evaluate an education programme for registered children's nurses to improve their knowledge, attitudes and confidence when caring for CYP admitted with self-harm. Methods and analysis: This mixed-methods evaluative study will involve a three-stage design. Stage 1: A priority-setting workshop will be conducted with 19 registered children's nurses. A Delphi technique will be used to establish consensus of information needs. Stage 2: An online educational intervention will be co-produced with 25 CYP and 19 registered children's nurses based on the priorities identified in Stage 1. Stage 3: The intervention will be implemented and evaluated with 250 registered children's nurses at a single hospital. Online Likert scale questionnaires will be administered at baseline and postintervention to assess levels of knowledge, attitudes and confidence in caring for CYP who self-harm. Descriptive and inferential statistics will be used to analyse the data. Statistical significance will be assessed at the 5% (two-sided) level. One-to-one qualitative interviews will also be undertaken with approximately 25 participants to explore any perceived impact on clinical practice. An interpretive descriptive approach will guide qualitative data collection and analysis. Ethics and dissemination: This study aims to develop, trial and evaluative a service-user, co-produced education programme for acute hospital registered children's nurses to improve the care of CYP admitted due to self-harm. The study has ethical approval from the National Health Services Research Ethics Committee and full governance clearance

A protein-protein interaction underlies the molecular basis for substrate recognition by an adenosine-to-inosine RNA-editing enzyme

Adenosine deaminases that act on RNA (ADARs) convert adenosine to inosine within double-stranded regions of RNA, resulting in increased transcriptomic diversity, as well as protection of cellular double-stranded RNA (dsRNA) from silencing and improper immune activation. The presence of dsRNA-binding domains (dsRBDs) in all ADARs suggests these domains are important for substrate recognition; however, the role of dsRBDs in vivo remains largely unknown. Herein, our studies indicate the Caenorhabditis elegans ADAR enzyme, ADR-2, has low affinity for dsRNA, but interacts with ADR-1, an editing-deficient member of the ADAR family, which has a 100-fold higher affinity for dsRNA. ADR-1 uses one dsRBD to physically interact with ADR-2 and a second dsRBD to bind to dsRNAs, thereby tethering ADR-2 to substrates. ADR-2 interacts with >1200 transcripts in vivo, and ADR-1 is required for 80% of these interactions. Our results identify a novel mode of substrate recognition for ADAR enzymes and indicate that protein-protein interactions can guide substrate recognition for RNA editors

Pittsboro, North Carolina, Chatham County : an action-oriented community diagnosis including secondary data analysis and qualitative data collection

PURPOSE OF COMMUNITY DIAGNOSIS The Chatham Coalition for Adolescent Health and five graduate students from the Department of Health Behavior and Health Education at the UNC School of Public Health collaborated to conduct this community diagnosis of Pittsboro’s adolescents. The purpose of this community diagnosis was to learn about the health and quality of life concerns of residents of Pittsboro, both adult and adolescent, and the resources and strengths that exist in the town for dealing with these concerns. The community diagnosis process used primary and secondary data to discover and analyze both the concerns and strengths of Pittsboro and its adolescents. INTRODUCTION TO OUR COMMUNITY Pittsboro is a small, semi-rural, Southern town that has been in existence for over 200 years. It is the Chatham County seat, located 35 miles west of Raleigh and 17 miles south of Chapel Hill. The town was founded in 1787 and until recently, the population increased very little. The “quaint” downtown is Mecca for antiques lovers, and features over ten antiques stores. In addition, there are several old-fashioned country stores, and a local farmers market situated in the town fairgrounds. However, while antique shopping and tourism entice many to come to Pittsboro, the cornerstone of the community is the people who live, work, and are educated there. Within the larger community of Pittsboro, we focused on adolescents. These teens, ages 11-18, either live or work in the town of Pittsboro or attend school in the Pittsboro District. While many of the adolescents do not actually live in the town of Pittsboro proper, those who work or go to school in the district are just as much influenced by the resources and activities in Pittsboro as are those who live there. This is particularly the case with after-school activities and the county health, educational, and recreational resources that are within reasonable distance of the schools and places of employment. Because we were working in Pittsboro with the Chatham County Coalition for Adolescent Health, it was not difficult to identify teens as our target population. The challenge came in determining which adolescents to include: only those who live within the city limits or residents as well as those who go to school or work in town. Through communications with our preceptor and the service providers we interviewed, it became clear that including the teens who come into Pittsboro daily, for school or work, along with teen residents was necessary since they all have access to the various county departments and other resources in the town and convene at local places such as convenience stores and restaurants. While adolescents are an integral part of Pittsboro, they are a group that tends not to have a collective voice. In addition, it became apparent from the interviews that we conducted that there are several issues facing the entire Pittsboro population that have both direct and indirect effects on the adolescent community. In particular, the growing number of businesses turning teens away, the lack of funding for a city-run recreational center, and the community’s lack of awareness about the existing Teen Center have precluded the ability of teens to convene in a single setting or come together around organized activities. According to one service provider, the consequence is that teens have lost their sense of community and are increasingly prevented from gaining it back. Hence, while we have defined Pittsboro as our community and teens as our focus within that community, the teens may not, in fact, sense that they belong to it. Our intent through this community diagnosis is to help Pittsboro recognize the strengths and needs of its teens and take ownership over the issues relevant to them in order to help the adolescents find their own voice and role within the larger community.Master of Public Healt

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia

Introduction: Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance.Methods: Twenty community-dwelling female subjects participated in the study (age = 43.4 ±20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht2), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m2 determined participant assignment into the Normal LBM and Low LBM subgroups.Results: The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht2 (adj. R2 = .61, p \u3c .001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R2 = .85, p \u3c .001). Scaled peak force was associated with age and echogenicity (adj. R2 = .53, p \u3c .001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p \u3c .05).Conclusions: Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht2 in women. In addition, ultrasound proxy measures of muscle quality are more strongly associated with strength than muscle mass within the study sample

Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia

Introduction: Age-related changes in muscle mass and muscle tissue composition contribute to diminished strength in older adults. The objectives of this study are to examine if an assessment method using mobile diagnostic ultrasound augments well-known determinants of lean body mass (LBM) to aid sarcopenia staging, and if a sonographic measure of muscle quality is associated with muscle performance.Methods: Twenty community-dwelling female subjects participated in the study (age = 43.4 ±20.9 years; BMI: 23.8, interquartile range: 8.5). Dual energy X-ray absorptiometry (DXA) and diagnostic ultrasound morphometry were used to estimate LBM. Muscle tissue quality was estimated via the echogenicity using grayscale histogram analysis. Peak force was measured with grip dynamometry and scaled for body size. Bivariate and multiple regression analyses were used to determine the association of the predictor variables with appendicular lean mass (aLM/ht2), and examine the relationship between scaled peak force values and muscle echogenicity. The sarcopenia LBM cut point value of 6.75 kg/m2 determined participant assignment into the Normal LBM and Low LBM subgroups.Results: The selected LBM predictor variables were body mass index (BMI), ultrasound morphometry, and age. Although BMI exhibited a significant positive relationship with aLM/ht2 (adj. R2 = .61, p \u3c .001), the strength of association improved with the addition of ultrasound morphometry and age as predictor variables (adj. R2 = .85, p \u3c .001). Scaled peak force was associated with age and echogenicity (adj. R2 = .53, p \u3c .001), but not LBM. The Low LBM subgroup of women (n = 10) had higher scaled peak force, lower BMI, and lower echogenicity values in comparison to the Normal LBM subgroup (n = 10; p \u3c .05).Conclusions: Diagnostic ultrasound morphometry values are associated with LBM, and improve the BMI predictive model for aLM/ht2 in women. In addition, ultrasound proxy measures of muscle quality are more strongly associated with strength than muscle mass within the study sample

A developmental framework linking neurogenesis and circuit formation in the Drosophila CNS.

The mechanisms specifying neuronal diversity are well characterized, yet it remains unclear how or if these mechanisms regulate neural circuit assembly. To address this, we mapped the developmental origin of 160 interneurons from seven bilateral neural progenitors (neuroblasts) and identify them in a synapse-scale TEM reconstruction of the Drosophila larval central nervous system. We find that lineages concurrently build the sensory and motor neuropils by generating sensory and motor hemilineages in a Notch-dependent manner. Neurons in a hemilineage share common synaptic targeting within the neuropil, which is further refined based on neuronal temporal identity. Connectome analysis shows that hemilineage-temporal cohorts share common connectivity. Finally, we show that proximity alone cannot explain the observed connectivity structure, suggesting hemilineage/temporal identity confers an added layer of specificity. Thus, we demonstrate that the mechanisms specifying neuronal diversity also govern circuit formation and function, and that these principles are broadly applicable throughout the nervous system

Co-producing a digital educational programme for registered children’s nurses to improve care of children and young people admitted with self-harm

Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children’s nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses’ knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery

Distributed Subnetworks of Depression Defined by Direct Intracranial Neurophysiology

Major depressive disorder is a common and disabling disorder with high rates of treatment resistance. Evidence suggests it is characterized by distributed network dysfunction that may be variable across patients, challenging the identification of quantitative biological substrates. We carried out this study to determine whether application of a novel computational approach to a large sample of high spatiotemporal resolution direct neural recordings in humans could unlock the functional organization and coordinated activity patterns of depression networks. This group level analysis of depression networks from heterogenous intracranial recordings was possible due to application of a correlational model-based method for inferring whole-brain neural activity. We then applied a network framework to discover brain dynamics across this model that could classify depression. We found a highly distributed pattern of neural activity and connectivity across cortical and subcortical structures that was present in the majority of depressed subjects. Furthermore, we found that this depression signature consisted of two subnetworks across individuals. The first was characterized by left temporal lobe hypoconnectivity and pathological beta activity. The second was characterized by a hypoactive, but hyperconnected left frontal cortex. These findings have applications toward personalization of therapy