The Influence of Comorbidity and Perceived Complexity on Outcomes of Referrals to Children and Young Person Mental Health Services (UK): A Mixed Methods Vignette Study

Children and young people (CYP) with long-term physical conditions (LTCs) are four times more likely to develop mental health disorders yet many cannot access Children and Young People's Mental Health Services (CYPMHS) or evidence-based interventions. This study aimed to understand the reasons for this; presence of an LTC neurodevelopmental disorder, or service requirements. 79 CYP mental health practitioners were randomly assigned to read vignettes depicting a hypothetical referral letter for a child with a mental health condition alone (n = 27), mental health condition and LTC (n = 25), or mental health condition and neurodevelopmental disorder (Autism Spectrum Disorder-ASD) (n = 27), answering questions about their likelihood of accepting the referral and proposed treatment plan. There were no significant differences between accessing CYPMHS or being offered first line evidence-based interventions in those with a LTC or ASD compared to those without. However, additional perceived complexity was frequently provided as a reason for rejecting referrals and not offering evidence-based intervention, with clinicians' predicted success of intervention significantly lower for these CYP. Clinicians were significantly more likely to suggest adapting the intervention in the LTC and the ASD groups to account for additional perceived complexity. The research suggests a need for additional services for CYP with LTCs and those with neurodevelopmental disorders, as well as training/awareness for clinicians

Phylogeny of the Subfamilies of Ichneumonidae (Hymenoptera)

A combined morphological and molecular phylogenetic analysis was performed to evaluate the subfamily relationships of the parasitoid wasp family Ichneumonidae (Hymenoptera). Data were obtained by coding 135 morphological and 6 biological characters for 131 exemplar species of ichneumonids and 3 species of Braconidae (the latter as outgroups). The species of ichneumonids represent all of the 42 currently recognized subfamilies. In addition, molecular sequence data (cytochrome oxidase I “DNA barcoding” region, the D2 region of 28S rDNA and part of the F2 copy of elongation factor 1-alpha) were obtained from specimens of the same species that were coded for morphology (1309 base pairs total). The data were analyzed using parsimony and Bayesian analyses. The parsimony analysis using all data recovered previ-ously recognized informal subfamily groupings (Pimpliformes, Ophioniformes, Ichneumoniformes), al-though the relationships of these three groups to each other differed from previous studies and some of the subfamily relationships within these groupings had not previously been suggested. Specifically, Ophioni-formes was the sister group to (Ichneumoniformes + Pimplformes), and Labeninae was placed near Ich-neumoniformes, not as sister group to all Ichneumonidae except Xoridinae. The parsimony analysis using only morphological characters was poorly resolved and did not recover any of the three informal subfamily groupings and very few of the relationships were similar to the total-evidence parsimony analysis. The mo-lecular-only parsimony analysis and both Bayesian analyses (total-evidence and molecular-only) recovered Pimpliformes, a restricted Ichneumoniformes grouping and many of the subfamily groupings recovered in the total-evidence parsimony analysis. A comparison and discussion of the results obtained by each phylo-genetic method and different data sets is provided. It is concluded that the molecular characters produced results that were relatively consistent with traditional, non-phylogenetic concepts of relationships between the ichneumonid subfamilies, whereas the morphological characters did not (at least not by themselves). The inclusion of both molecular and morphological characters using parsimony produced a topology that was the closest to the traditional subfamily relationships. The method of analysis did not greatly affect the overall topology for the molecular-only analyses, but there were differences between Bayesian and parsi-mony results for the total-evidence analyses (especially near the root of the tree). The Bayesian results did not seem to be altered very much by the inclusion of morphological characters, unlike in the parsimony analysis. In summary, the following groups were supported in multiple analyses regardless of the characters used or method of tree-building: Pimpliformes, higher Ophioniformes, higher Pimpliformes, (Claseinae + Pedunculinae), (Banchinae + Stilbopinae), Campopleginae, Cremastinae, Diplazontinae, Ichneumoninae (including Alomya), Labeninae, Ophioninae, Poemeniinae, Rhyssinae, and Tersilochinae sensu stricto. Conversely, Ctenopelmatinae and Tryphoninae were never recovered without inclusion of other taxa. Based on the hypothesis of relationships obtained by the total-evidence parsimony analysis, the following formal taxonomic changes are proposed: Alomyinae Förster (= Alomya Panzer and Megalomya Uchida) is once again synonymized with Ichneumoninae and is now considered a tribe (Alomyini rev. stat.); and Notostilbops Townes is transferred from Stilbopinae to Banchinae, tribe Atrophini

Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis

BACKGROUND: Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access. METHODS: A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery. RESULTS: Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity psychological interventions were equivalent on reducing eating disorder psychopathology (g = - 0.13), more effective at improving DSM severity specifier-related outcomes (g = - 0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes. CONCLUSION: Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder

Opening opportunities for high-resolution isotope analysis - Quantification of δ15NNO3 and δ18ONO3 in diffusive equilibrium in thin–film passive samplers

The fate of nitrate transported across groundwater-surface water interfaces has been intensively studied in recent decades. The interfaces between aquifers and rivers or lakes have been identified as biogeochemical hotspots with steep redox gradients. However, a detailed understanding of the spatial heterogeneity and potential temporal variability of these hotspots, and the consequences for nitrogen processing, is still hindered by a paucity of adequate measurement techniques. A novel methodology is presented here, using Diffusive Equilibrium in Thin-film (DET) gels as high-spatial-resolution passive-samplers of δ15NNO3 and δ18ONO3 to investigate nitrogen cycling. Fractionation of δ15NNO3 and δ18ONO3 during diffusion of nitrate through the DET gel was determined using varying equilibrium times and nitrate concentrations. This demonstrated that nitrate isotopes of δ15NNO3 and δ18ONO3 do not fractionate when sampled with a DET gel. δ15NNO3 values from the DET gels ranged between 2.3 ± 0.2 and 2.7 ± 0.3‰ for a NO3– stock solution value of 2.7 ± 0.4‰, and δ18ONO3 values ranged between 18.3 ± 1.0 and 21.5 ± 0.8‰ for a NO3– stock solution of 19.7 ± 0.9‰. Nitrate recovery and isotope values were independent of equilibrium time and nitrate concentration. Additionally, an in situ study showed that nitrate concentration and isotopes provide unique, high-resolution data that enable improved understanding of nitrogen cycling in freshwater sediments

Feasibility of low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions: a case series

Background: Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. / Method: A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals, and quality of life, at baseline, during treatment, and six-month follow-up. / Results: Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. / Conclusions: Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable, and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings

Feasibility, acceptability and preliminary effectiveness of a mental health drop-in centre for the siblings of young people attending a paediatric hospital

Siblings of children with long-term conditions (LTCs) can have significantly elevated mental health needs, but these are often overlooked. A pragmatic single-arm feasibility pilot assessed feasibility, acceptability and preliminary effectiveness of a drop-in centre in a paediatric hospital addressing mental health needs of patients with LTCs, their carers and siblings. The drop-in centre accepted self-referral and supplemented existing provision offering a suite of interventions, including signposting, diagnostic assessments and/or guided self-help. This paper reports on feasibility, acceptability and preliminary outcomes of this centre for siblings. Eighteen siblings aged 2-17 used the centre. Sixteen of their parents completed the Strengths and Difficulties Questionnaires at baseline and 6 months post-baseline, and ten completed parent-reported PedsQL across two time points. Preliminary effectiveness results demonstrated a decrease in mental health symptoms with large effect size (score reduction of 3.44, 95% CI [1.25, 5.63], d = 0.84) and small effect on quality of life, with scores increasing from a median of 69.91, 95% CI [53.57, 91.67], to a median of 80.44, 95% CI [67.39, 89.13], r = 0.11 for these siblings. 88% of parents were satisfied with this provision for their sibling child. This study highlights the feasibility and value of assessing siblings for emotional and behavioural difficulties and providing them with an accessible, effective and acceptable intervention

THz and mm-Wave Sensing of Corneal Tissue Water Content: Electromagnetic Modeling and Analysis.

Terahertz (THz) spectral properties of human cornea are explored as a function of central corneal thickness (CCT) and corneal water content, and the clinical utility of THz-based corneal water content sensing is discussed. Three candidate corneal tissue water content (CTWC) perturbations, based on corneal physiology, are investigated that affect the axial water distribution and total thickness. The THz frequency reflectivity properties of the three CTWC perturbations were simulated and explored with varying system center frequency and bandwidths (Q-factors). The modeling showed that at effective optical path lengths on the order of a wavelength the cornea presents a lossy etalon bordered by air at the anterior and the aqueous humor at the posterior. The simulated standing wave peak-to-valley ratio is pronounced at lower frequencies and its effect on acquired data can be modulated by adjusting the bandwidth of the sensing system. These observations are supported with experimental spectroscopic data. The results suggest that a priori knowledge of corneal thickness can be utilized for accurate assessments of corneal tissue water content. The physiologic variation of corneal thickness with respect to the wavelengths spanned by the THz band is extremely limited compared to all other structures in the body making CTWC sensing unique amongst all proposed applications of THz medical imaging

Can metaphysical structuralism solve the plurality problem?

Metaphysics has a problem with plurality: in many areas of discourse, there are too many good theories, rather than just one. This embarrassment of riches is a particular problem for metaphysical realists who want metaphysics to tell us the way the world is and for whom one theory is the correct one. A recent suggestion is that we can treat the different theories as being functionally or explanatorily equivalent to each other, even though they differ in content. The aim of this paper is to explore whether the notion of functionally equivalent theories can be extended and utilized in the defence of metaphysical realism, drawing upon themes from structuralism in the philosophies of mathematics and science in which the specifics of theories do not matter as long as the relations in which they stand to other theories are maintained. I argue that despite its initial attractiveness, there are significant difficulties with this proposal. Discovering these obstacles (most probably) thwarts the realist structuralist project, but reveals interesting features of metaphysical systems