Associations between family and clinician ratings of child mental health: a study of UK CAMHS assessments and outcomes

Background: The rated severity of child mental health problems depends on who is doing the rating, whether child, carer or clinician. It is important to know how these ratings relate to each other. Aims: To investigate to what extent clinicians’ views are associated with carers’ and young people’s views in routine care in the United Kingdom. Method: Ratings of clinician and parent/child viewpoints from a large Child and Adolescent Mental Health Services (CAMHS) sample (ns 1773–47,299), as measured by the Children’s Global Assessment Scale (CGAS) and Strengths and Difficulties Questionnaire (SDQ) respectively, were analysed. The parent SDQ added value score (AVS), which adjusts for regression to the mean and other non-treatment change, was also included in the analyses. Results: Small-to-medium correlations were found between family and clinician ratings; however, ratings diverged for the lowest-function CGAS bands. Regression analyses showed that pro-social ratings from both child and parent contributed to clinician ratings. Knowing child-reported emotional problem severity made parent ratings of emotions irrelevant to clinician judgements. There was a positive association between SDQ AVS and CGAS; as hypothesised, CGAS showed more change than the SDQ AVS, suggesting that clinicians over-estimate change. Conclusion: This study shows the importance of multi-informant data gathering and the integration of multiple views by clinicians when monitoring outcomes

Why do so many white working class boys underachieve? An exploration of underpinning factors and beliefs

The media and current literature portray white working class boys as educational failures with restricted life chances. To date, no mixed methods research has been conducted to explore these commonly held views. This study serves as a starting point, taking what we know about achievement and exploring this from the perspective of WWCBs. A two-phase sequential mixed methods exploratory design was used with purposive sampling. All participants were in key stage 3, recorded as white British, in receipt of free school meals and attending a comprehensive secondary school. Participants were categorised as low or high/average attaining, based on their current attainment levels. In phase 1, the School Attitude Assessment Survey-Revised (McCoach, 2002) was used to measure participants’ attitudes on five factors known to be associated with achievement. This data was then analysed using an independent samples T-test. Phase 2 included low attaining pupils only and, using semi-structured interviews, explored the boy’s views and beliefs about schooling. In phase 1, the low and high/average groups did not significantly differ in their academic self-perceptions, attitudes towards school, attitudes towards teachers, goal valuation or self-regulation and motivation. Phase 2 used thematic analysis to explore the interview data of six year 9 boys and identified four over-arching themes: feeling valued in the learning relationship, academic self-perceptions, choosing one’s own path and misalignment. The quantitative phase results indicated that the academic attainment of the participating white working class boys (WWCBs) was not significantly mediated by factors measured by the SAAS-R, and commonly believed to affect achievement. The findings from the qualitative phase supported these findings and generated alternative factors that highlighted the importance of considering the reciprocal nature of education and the effect of relationships on learning. The data suggests a unilateral within child view may not be sufficient in understanding why working class boys underachieve

Severe Adult-Onset Non-Dystrophic Myotonia With Apnea and Laryngospasm Due to Digenic Inheritance of SCN4A and CLCN1 Variants: A Case Report.

ObjectivesTo report a case of adult-onset non-dystrophic myotonia complicated by recurrent episodes of laryngospasm.MethodsThe patient is a 35-year-old man who was admitted to our hospital for recurrent episodes of apnea requiring endotracheal intubation with mechanical ventilation. He underwent extensive evaluation, including EMG, laryngoscopy, muscle biopsy, and genetic testing, which revealed a diagnosis of non-dystrophic myotonia.ResultsHis myotonic disorder was due to the synergistic effects of a pathogenic CLCN1 variant and a newly reported SCN4A variant. His muscle biopsy demonstrated myofibrillar disorganization with Z-band streaming, which may reflect the severity of his clinical and electrographic myotonia. Treatment with mexiletine resulted in resolution of his episodes of laryngospasm and symptoms of myotonia in the extremities.DiscussionOur case adds to the literature on the potentiating effects of chloride channelopathies on sodium channel myotonia. This is the first reported case of an adult-onset sodium channelopathy manifesting with respiratory failure due to laryngospasm. In addition, we present muscle biopsy findings that have not been described in the recent literature. This case also highlights that a myotonic disorder should be considered in the differential diagnosis for recurrent episodes of mixed hypoxic and hypercarbic respiratory failure

“I am now being who I am and I’m proud of it”: Hair related personal and social identity and subjective wellbeing of older Black women in the UK

Hair is an important personal attribute defined by the person’s natural hair shape, form and colour as well as by age and health. The hair of Black women has a specific curly texture that has been commonly manipulated to resemble straighter European hair, following centuries of oppressive beauty norms. The biological hair aging also presents challenges to some women due to the traditional social constructs of beauty and the persistent pressure on women to maintain their appearance. This interdisciplinary study explores the evolution of hair management practices of Black women from age-related biological, personal, social and well-being perspectives. A mixed methods approach was adopted, based on an online survey (n=46) followed by in depth semi-structured interviews (n=10). A statistically significant shift towards less frequent use of complex hair styles and visits to the hairdressers over a 30-year period was found, but frequency of hair colouring was not impacted. Three main qualitative themes were identified: 1) managing hair greying represented an important age-related negotiation of personal and social identity; 2) curly hair texture remained a strong personal and cultural identity symbol in light of historical dominance of Eurocentric hair beauty standards and hair-based discrimination; and 3) subjective well-being was strengthened by increased confidence in one’s personal hair aesthetics and better-informed choices about hair management. Overall, age did not diminish the desire to maintain good hair. Increasing the visibility of older Black women’s hair will further support their capacity to negotiate their presence and participation in social and professional contexts and to enhance their subjective well-being

Hair ageing in Black women (age>59): impact on personal and social identity and subjective wellbeing

This interdisciplinary study explores the evolution of hair management practices of Black women from age-related biological, personal and social perspectives. It seeks to clarify if and how any changes impact the subjective wellbeing of women. The study focuses on Black women living in the UK who are 59 years old and over as biological changes to hair become more prominent after menopause. The study contributes to raising the visibility of this group of women who appear underrepresented in the research fields of hair science, well-being and ageing as well as in the media

Diseño de una red con tecnología laser inalámbrica para el campus de la Universidad Católica de Santiago de Guayaquil.

El presente trabajo de investigación tiene por objeto el análisis y diseño de una red con tecnología láser Free-Space-Optics (FSO), para el campus de la Universidad Católica de Santiago de Guayaquil y su comparación con la red de fibra óptica existente. FSOes una tecnología en la que se crean enlaces ópticos inalámbricos mediante láser y es comparable con los sistemas de comunicaciones ópticas por medio de fibra. El Campus de la UCSGes un escenario perfecto para realizar un estudio de la tecnología FSO y así tener una idea clara de la ventajas y desventajas que presenta dicha tecnología en un entorno LAN frente a otras soluciones como es el caso de la fibra óptica. Se destacan las ventajas de esta tecnología, los factores que limitan el desempeño de los sistemas FSO para poder obtener resultados óptimos en la operación de los enlaces ópticos inalámbricos. Finalmente se realiza un estudio de costos entre la tecnología FSO y la fibra óptica donde se podrá destacar los potenciales beneficios de esta tecnología

Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway.

BackgroundDelirium is associated with poor clinical outcomes that could be improved with targeted interventions.ObjectiveTo determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.MethodsThis retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.ResultsAdjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002).ConclusionThis multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort

Detection of High‐Risk Paraneoplastic Antibodies against TRIM9 and TRIM67 Proteins

ObjectiveCo-occurring anti-tripartite motif-containing protein 9 and 67 autoantibodies (TRIM9/67-IgG) have been reported in only a very few cases of paraneoplastic cerebellar syndrome. The value of these biomarkers and the most sensitive methods of TRIM9/67-IgG detection are not known.MethodsWe performed a retrospective, multicenter study to evaluate the cerebrospinal fluid and serum of candidate TRIM9/67-IgG cases by tissue-based immunofluorescence, peptide phage display immunoprecipitation sequencing, overexpression cell-based assay (CBA), and immunoblot. Cases in which TRIM9/67-IgG was detected by at least 2 assays were considered TRIM9/67-IgG positive.ResultsAmong these cases (n = 13), CBA was the most sensitive (100%) and revealed that all cases had TRIM9 and TRIM67 autoantibodies. Of TRIM9/67-IgG cases with available clinical history, a subacute cerebellar syndrome was the most common presentation (n = 7/10), followed by encephalitis (n = 3/10). Of these 10 patients, 70% had comorbid cancer (7/10), 85% of whom (n = 6/7) had confirmed metastatic disease. All evaluable cancer biopsies expressed TRIM9 protein (n = 5/5), whose expression was elevated in the cancerous regions of the tissue in 4 of 5 cases.InterpretationTRIM9/67-IgG is a rare but likely high-risk paraneoplastic biomarker for which CBA appears to be the most sensitive diagnostic assay. ANN NEUROL 2023;94:1086-1101

Serotonin, β‐amyloid, and cognition in Parkinson disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144631/1/ana25236_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144631/2/ana25236.pd