Training paediatric hospital workforces to deliver low-intensity CBT for children and young people with mental health needs in the context of long term conditions

Introduction: Despite children and young people (CYP) with long term conditions (LTCs) having significantly elevated mental health needs, accessing evidence-based psychological support remains difficult. Previous work suggests low-intensity CBT (LICBT) interventions are effective for CYP with mental health needs in the context of LTCs. If embedded in hospitals LICBT may increase access and better integrate physical and mental health care. This new provision is currently being implemented in paediatric hospitals across the UK. A vital part of successful implementation is effective training. The current paper describes hybrid training in LICBT interventions delivered to staff from a range of health care settings. The aim of the study was to analyse the effectiveness of, and satisfaction with, this training. // Methods: Two days of hybrid training in LICBT for mental health needs in the context of LTCs were delivered to staff. Attendees were introduced to LICBT strategies to support CYP with anxiety, depression and challenging behaviour. A brief questionnaire and evaluation form were completed before and after training on attendees’ understanding of the topics covered and their views of the training (usefulness, relevance, preparedness). // Results: Thirteen attendees completed the questionnaire before and after training was completed. Total scores significantly increased from pre-training to post-training. Qualitative feedback indicated the majority found the training highly relevant to their work and enjoyed the hybrid model. // Conclusion: These findings support the acceptability and effectiveness of two-day hybrid training as part of enabling a paediatric hospital workforce to deliver psychological support for CYP with LTCs. Future training could consider this format to help overcome barriers to successful implementation. This work highlights the opportunity a new or existing workforce holds in integrating psychological therapies into existing physical health care pathways, coordinating care and ensuring equitable access to mental health support for CYPs, irrespective of their LTCs

Regional-scale probabilistic shoreline evolution modelling for flood-risk assessment

Rapid deterministic modelling of shoreline evolution at regional and coastal-scheme scale enables Monte-Carlo simulations by which long-term shoreline statistics can be estimated. This paper describes UnaLinea, a fast, accurate finite difference solver of the one-line sediment continuity equation. The model is verified for the evolution of an initially straight shoreline of a plane beach subject to regular breaking waves at constant angle of incidence in the presence of either a groyne or a continuous single-point feed of sediment. Grid convergence and stability tests are used to obtain accurate, stable results, with satisfactory computational efficiency. Influences of wave input filtering and event-based sediment loading are considered. The rapid deterministic model is applied to Monte-Carlo simulations of the evolution of the west coast of Calabria, Italy for different scenarios including increased sediment load from a river and selected beach nourishment. The potential role of probabilistic shoreline evolution in regional coastal flood-risk assessment is explored through application to an idealised stretch of the Holderness coastline, U.K., where flood depths and expected damage are estimated for a 1000 year return period event

Alterations in cerebral blood flow and cerebrovascular reactivity during 14 days at 5050 m

Upon ascent to high altitude, cerebral blood flow (CBF) rises substantially before returning to sea-level values. The underlying mechanisms for these changes are unclear. We examined three hypotheses: (1) the balance of arterial blood gases upon arrival at and across 2 weeks of living at 5050 m will closely relate to changes in CBF; (2) CBF reactivity to steady-state changes in CO2 will be reduced following this 2 week acclimatisation period, and (3) reductions in CBF reactivity to CO2 will be reflected in an augmented ventilatory sensitivity to CO2. We measured arterial blood gases, middle cerebral artery blood flow velocity (MCAv, index of CBF) and ventilation () at rest and during steady-state hyperoxic hypercapnia (7% CO2) and voluntary hyperventilation (hypocapnia) at sea level and then again following 2–4, 7–9 and 12–15 days of living at 5050 m. Upon arrival at high altitude, resting MCAv was elevated (up 31 ± 31%; P < 0.01; vs. sea level), but returned to sea-level values within 7–9 days. Elevations in MCAv were strongly correlated (R2= 0.40) with the change in ratio (i.e. the collective tendency of arterial blood gases to cause CBF vasodilatation or constriction). Upon initial arrival and after 2 weeks at high altitude, cerebrovascular reactivity to hypercapnia was reduced (P < 0.05), whereas hypocapnic reactivity was enhanced (P < 0.05 vs. sea level). Ventilatory response to hypercapnia was elevated at days 2–4 (P < 0.05 vs. sea level, 4.01 ± 2.98 vs. 2.09 ± 1.32 l min−1 mmHg−1). These findings indicate that: (1) the balance of arterial blood gases accounts for a large part of the observed variability (∼40%) leading to changes in CBF at high altitude; (2) cerebrovascular reactivity to hypercapnia and hypocapnia is differentially affected by high-altitude exposure and remains distorted during partial acclimatisation, and (3) alterations in cerebrovascular reactivity to CO2 may also affect ventilatory sensitivity

Isoform-specific AMPK association with TBC1D1 is reduced by a mutation associated with severe obesity

AMP-activated protein kinase (AMPK) is a key regulator of cellular and systemic energy homeostasis which achieves this through the phosphorylation of a myriad of downstream targets. One target is TBC1D1 a Rab-GTPase-activating protein that regulates glucose uptake in muscle cells by integrating insulin signalling with that promoted by muscle contraction. Ser237 in TBC1D1 is a target for phosphorylation by AMPK, an event which may be important in regulating glucose uptake. Here, we show AMPK heterotrimers containing the α1, but not the α2, isoform of the catalytic subunit form an unusual and stable association with TBC1D1, but not its paralogue AS160. The interaction between the two proteins is direct, involves a dual interaction mechanism employing both phosphotyrosinebinding (PTB) domains of TBC1D1 and is increased by two different pharmacological activators of AMPK (AICAR and A769962). The interaction enhances the efficiency by which AMPK phosphorylates TBC1D1 on its key regulatory site, Ser237. Furthermore, the interaction is reduced by a naturally occurring R125W mutation in the PTB1 domain of TBC1D1, previously found to be associated with severe familial obesity in females, with a concomitant reduction in Ser237 phosphorylation. Our observations provide evidence for a functional difference between AMPK α-subunits and extend the repertoire of protein kinases that interact with substrates via stabilisation mechanisms that modify the efficacy of substrate phosphorylation

Frontally mediated inhibitory processing and white matter microstructure: age and alcoholism effects

RationaleThe NOGO P3 event-related potential is a sensitive marker of alcoholism, relates to EEG oscillation in the δ and θ frequency ranges, and reflects activation of an inhibitory processing network. Degradation of white matter tracts related to age or alcoholism should negatively affect the oscillatory activity within the network.ObjectiveThis study aims to evaluate the effect of alcoholism and age on δ and θ oscillations and the relationship between these oscillations and measures of white matter microstructural integrity.MethodsData from ten long-term alcoholics to 25 nonalcoholic controls were used to derive P3 from Fz, Cz, and Pz using a visual GO/NOGO protocol. Total power and across trial phase synchrony measures were calculated for δ and θ frequencies. DTI, 1.5 T, data formed the basis of quantitative fiber tracking in the left and right cingulate bundles and the genu and splenium of the corpus callosum. Fractional anisotropy and diffusivity (λL and λT) measures were calculated from each tract.ResultsNOGO P3 amplitude and δ power at Cz were smaller in alcoholics than controls. Lower δ total power was related to higher λT in the left and right cingulate bundles. GO P3 amplitude was lower and GO P3 latency was longer with advancing age, but none of the time-frequency analysis measures displayed significant age or diagnosis effects.ConclusionsThe relation of δ total power at CZ with λT in the cingulate bundles provides correlational evidence for a functional role of fronto-parietal white matter tracts in inhibitory processing

A Field Guide to Finding Fossils on Mars

The Martian surface is cold, dry, exposed to biologically harmful radiation and apparently barren today. Nevertheless, there is clear geological evidence for warmer, wetter intervals in the past that could have supported life at or near the surface. This evidence has motivated National Aeronautics and Space Administration and European Space Agency to prioritize the search for any remains or traces of organisms from early Mars in forthcoming missions. Informed by (1) stratigraphic, mineralogical and geochemical data collected by previous and current missions, (2) Earth's fossil record, and (3) experimental studies of organic decay and preservation, we here consider whether, how, and where fossils and isotopic biosignatures could have been preserved in the depositional environments and mineralizing media thought to have been present in habitable settings on early Mars. We conclude that Noachian‐Hesperian Fe‐bearing clay‐rich fluvio‐lacustrine siliciclastic deposits, especially where enriched in silica, currently represent the most promising and best understood astropaleontological targets. Siliceous sinters would also be an excellent target, but their presence on Mars awaits confirmation. More work is needed to improve our understanding of fossil preservation in the context of other environments specific to Mars, particularly within evaporative salts and pore/fracture‐filling subsurface minerals