Delivering clinical evidence-based child–parent interventions for emotional development through a digital platform: A feasibility trial

As the prevalence of mental health conditions in childhood increases, there are growing concerns around the accessibility and scale of evidence-based support. However, barriers to referral, time commitment and engagement rates means recommended traditional group-based parenting programmes are unable to provide population level support at scale. The aim of this feasibility study was to establish whether a suite of purposively constructed animated films and digital resources could positively impact on parent and child outcomes in the early years. Families from a range of backgrounds ( n = 129) participated in a mixed method evaluation of the digital programme. After completing online surveys and interviews, the test group was given access to the Embers the Dragon platform for 8 weeks whilst the control group continued as usual. 98% of test group parents showed an improvement in parental response in relation to effective parenting styles. During qualitative interviews, child participants verbally recalled an increased range of emotions and coping strategies highlighted in the programme. Digital interventions can be used to support children’s emotional development independent of clinicians and may provide a solution to sustainable family psychoeducation, thereby fulfilling a preventative agenda and potentially lessening the future impact on Child and Adolescent Mental Health Services

Exploring the linkages between education sector governance, inequity, conflict, and peacebuilding in South Sudan

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Enhanced volcanic activity and long-term warmth in the middle Eocene revealed by mercury and osmium isotopes from IODP Expedition 369 Site U1514

Rapid plate reorganization may have influenced global climate during the Eocene; however, its linkage remains poorly constrained, particularly during the middle Eocene. To elucidate this tectonic–climatic relationship, here, we conducted a comprehensive analysis based on high-resolution mercury (Hg) and osmium (Os) abundance and isotope data obtained from the complete Eocene sedimentary sequence of Site U1514, drilled in the Mentelle Basin off southwest Australia. The Hg signals in this sedimentary sequence, which are characterized by significantly high enrichment and insignificant mass-independent fractionation (Δ199Hg) signal, confirm that the middle Eocene (∼45–38 Ma) was a period of persistent, increased volcanism, accompanied by intense tectonic activity. In particular, a remarkable seafloor volcanic eruption persisted for approximately 1.5 million years (∼42.0–40.5 Ma), immediately preceding the Middle Eocene Climate Optimum (MECO). Contemporaneously, the trends toward a slightly more radiogenic seawater 187Os/188Os (Osi) composition denote the prevalence of intensified continental weathering under a warm, humid climate during the middle Eocene, a phenomenon particularly evident during the MECO. Importantly, the Hg and Os records from Site U1514 reveal the occurrence of a multi-million-year warming reversal amid the long-term Eocene cooling trend, which likely contributed to significant CO2 reduction during the late Eocene. These findings significantly enhance our understanding of Eocene climate dynamics, which are fundamentally linked to intensive tectonic-driven volcanic activity and associated continental chemical weathering

Using patient feedback to adapt intervention materials based on acceptance and commitment therapy for people receiving renal dialysis

Theory-based intervention materials must be carefully adapted to meet the needs of users with specific physical conditions. Acceptance and Commitment Therapy (ACT) has been adapted successfully for cancer, chronic pain, diabetes, irritable bowel syndrome, multiple sclerosis, and a range of other conditions, but not so far for people receiving renal haemodialysis. This paper presents findings from a study to adapt ACT-based intervention materials specifically for renal dialysis. Draft written materials consisting of four stories depicting fictitious individuals who used ACT-related techniques to help overcome different challenges and difficulties related to dialysis were adapted using a systematic patient consultation process. The participants were 18 people aged 19 to 80 years, with chronic kidney disease and receiving renal dialysis. Individual, semi-structured interviews were conducted to elicit participants’ views about how the content of the draft materials should be adapted to make them more realistic and relevant for people receiving renal dialysis and about how the materials should be presented and delivered to people receiving renal dialysis. The interview transcripts were analysed using a qualitative adaptation of the Delphi method in which themes are used as a framework for translating feedback into proposals for modifications. The analysis of patient feedback supported the use of patient stories but suggested they should be presented by video and narrated by real dialysis patients. They also indicated specific adaptations to make the stories more credible and realistic. Participant feedback was translated into proposals for change that were considered along with clinical, ethical and theoretical factors. The outcome was a design for a video-based intervention that separated the stories about individuals from the explanations of the specific ACT techniques and provided greater structure, with material organised into smaller chunks. This intervention is adapted specifically for people receiving renal dialysis while retaining the distinctive theoretical principles of ACT. The study shows the value of consulting patients in the development of intervention materials and illustrates a process for integrating patient feedback with theoretical, clinical and practical considerations in intervention design.Kidney Care UK and British Renal Society Joint Grants Partnership, and the University of Derby Research Investment Fund

Regional variations in quality of survival among men with prostate cancer across the United Kingdom

Purpose: Prostate cancer incidence, treatment and survival rates vary throughout the United Kingdom (UK) but little is known about regional differences in quality of survival. Objective: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances. Design, setting and participants: A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42 months previously. Outcome measurements and statistical analysis: Urinary, bowel, sexual problems and vitality were patient reported using the EPIC-26 questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. Results and limitations: 35,823 men responded; 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East & Cumbria, with more urinary incontinence in North-East & Cumbria and Peninsula, greater sexual problems in West Midlands and poorer vitality in North-East & Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pre-treatment conditions. Conclusions: Despite adjustment for treatment, clinical and socio-demographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regards bowel problems and vitality, where clinically relevant differences were reported. Patient summary: We conducted a UK-wide survey of patient’s quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow up care

Quality of life in men living with advanced and localised prostate cancer: A United Kingdom population-wide patient-reported outcome study of 30,000 men

Background. Little is known about the health-related quality of life (HRQL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQL in men with all stages of prostate cancer, and identify implications for healthcare delivery. Methods. Men alive 18-42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered which contained validated measures to assess a) functional outcomes (EPIC-26 plus use of interventions for sexual dysfunction) and b) generic HRQL (EQ-5D-5L & self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQL across diagnostic stage and self-reported treatment groups. Findings. 35,823 (60.8%) men responded. Stage was known for 85.8%; 19,599 (63.8%) stage I/II, 7,209 (23.4%) stage III, 3,925 (12.8%) stage IV. Functional outcomes: Poor sexual function was common (81.0%), regardless of stage, and over half of men (55.8%) received no intervention for this. Differences in urinary and bowel morbidity were greater with respect to treatment than stage. In men treated with androgen deprivation therapy (ADT), 30.7% reported moderate/big problems with hot flushes, 29.4% with lack of energy and 22.5% with weight gain. HRQL: Overall self-assessed health was similar in men with stage I-III disease, and whilst reduced in those with stage IV cancer, 23.5% with metastatic disease reported no problems on any EQ-5D dimension. Interpretation. Men diagnosed with advanced disease do not report markedly different HRQL outcomes to those diagnosed with localised disease, although substantial problems with hormonal function and fatigue are reported amongst men treated with ADT. Sexual dysfunction is common and the majority of men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the impact of ADT are required

Prevalence and architecture of de novo mutations in developmental disorders.

The genomes of individuals with severe, undiagnosed developmental disorders are enriched in damaging de novo mutations (DNMs) in developmentally important genes. Here we have sequenced the exomes of 4,293 families containing individuals with developmental disorders, and meta-analysed these data with data from another 3,287 individuals with similar disorders. We show that the most important factors influencing the diagnostic yield of DNMs are the sex of the affected individual, the relatedness of their parents, whether close relatives are affected and the parental ages. We identified 94 genes enriched in damaging DNMs, including 14 that previously lacked compelling evidence of involvement in developmental disorders. We have also characterized the phenotypic diversity among these disorders. We estimate that 42% of our cohort carry pathogenic DNMs in coding sequences; approximately half of these DNMs disrupt gene function and the remainder result in altered protein function. We estimate that developmental disorders caused by DNMs have an average prevalence of 1 in 213 to 1 in 448 births, depending on parental age. Given current global demographics, this equates to almost 400,000 children born per year