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Temporal aspects of child and adolescent time allocation in diverse cultural settings have been difficult to model using conventional statistical techniques. A new statistical approach, Egocentric Relational Event Modelling (EREM), allows for the simultaneous modelling of activity frequency, duration, and sequencing. Here, EREM is applied to a focal follow dataset of Congolese BaYaka forager child and adolescent play and work activities. Results show that, as children age, they engage in less frequent and extended play bouts and more frequent and extended work bouts. Bout frequency and duration were a more sensitive measure for early sex differences than overall time allocation. Sequential patterns of work and play suggest that these activities have short-term energetic trade-offs. This article demonstrates that EREM can reveal stable and variable patterns in child development.

Young people form the primary target demographic of new 'buy now pay later' (BNPL) and digital credit services. Despite consistent data showing young people as a cohort are particularly vulnerable to unsustainable levels of indebtedness, little is known about how young people define and make sense of the experience of being in debt through consumer credit services. This paper explores how indebtedness is experienced and understood in relation to wellbeing through a qualitative study using interviews alongside arts-based participatory methods of bodymapping and sandboxing with 24 young people in the Hunter region of NSW, Australia. These methods enabled particular attention to the embodied and affective elements related to the experience of indebtedness to understand debt's significance for wellbeing for young people. The embodied and affective registers of indebtedness are integral for understanding the conditions informing how wellbeing is negotiated and felt in this context. This study considers the role of BNPL services in young people's economic lives as part of broader processes of financialisation, and the significance of extended and ubiquitous forms of credit for young people's wellbeing. [ABSTRACT FROM AUTHOR]

Positive and negative parental affect influence developing parent--child attachment relationships, especially during infancy as well as children's social--emotional, academic, and behavioral functioning later in life. Increasingly, because both mothers and fathers can play central caregiving roles, the parenting qualities of both parents demand consideration. Therefore, this study investigated whether parental gender and caregiving role were associated with mothers' and fathers' positive affect and negative affect during interactions with their 4-month-old firstborn infant, while determining whether parenting stress, infant temperament, having a singleton/twin, and living in the Netherlands, France, or the United Kingdom were related to parental positive affect and negative affect. In all, 135 different-sex, same-sex male, and same-sex female couples (113 fathers and 157 mothers, comprising 147 primary, and 123 secondary caregivers) who conceived through artificial reproductive techniques were studied. The couples were videorecorded at home while in feeding, cleaning, and playing contexts to assess the levels of positive and negative parental affect. In addition, the couples completed questionnaires about their caregiving role, parenting stress, and the infants' temperament. Mixed linear models indicated that the levels of positive and negative parental affect toward the infant in all contexts were not related to parental gender, caregiving role, the interaction between parental gender and caregiving role, parenting stress, infant temperament, or singleton/twin status. However, the target parental behaviors were related to the country of origin, suggesting differences among Dutch, French, and British parents. Overall, we found no evidence that gender or caregiving roles were associated with the levels of positive and negative affect shown by the parents. [ABSTRACT FROM AUTHOR]

Sepsis is a heterogeneous condition defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For some, sepsis presents as a predominantly suppressive disorder, whilst others experience a pro-inflammatory condition which can culminate in a 'cytokine storm'. Frequently, patients experience signs of concurrent hyper-inflammation and immunosuppression, underpinning the difficulty in directing effective treatment. Although intensive care unit mortality rates have improved in recent years, one-third of discharged patients die within the following year. Half of post-sepsis deaths are due to exacerbation of pre-existing conditions, whilst half are due to complications arising from a deteriorated immune system. It has been suggested that the intense and dysregulated response to infection may induce irreversible metabolic reprogramming in immune cells. As a critical arm of immune protection in vertebrates, alterations to the adaptive immune system can have devastating repercussions. Indeed, a marked depletion of lymphocytes is observed in sepsis, correlating with increased rates of mortality. Such sepsis-induced lymphopenia has profound consequences on how T cells respond to infection but equally on the humoral immune response that is both elicited by B cells and supported by distinct CD4+ T follicular helper (TFH) cell subsets. The immunosuppressive state is further exacerbated by functional impairments to the remaining lymphocyte population, including the presence of cells expressing dysfunctional or exhausted phenotypes. This review will specifically focus on how sepsis destabilises the adaptive immune system, with a closer examination on how B cells and CD4+ TFH cells are affected by sepsis and the corresponding impact on humoral immunity. [ABSTRACT FROM AUTHOR]

Prescribing for children and young people highlights many complex issues that may not be relevant in other fields of non-medical prescribing. Ongoing changes to legislation pose challenges, requiring paediatric non-medical prescribers to be vigilant in their daily prescribing practice. This article aims to address pertinent challenges and barriers frequently seen in prescribing for children and young people, including not only organisational and human factors, but also legal issues, controversial prescribing, education, the impact of the recent Covid-19 pandemic, and how that has influenced the rise in childhood obesity, in itself an important element. [ABSTRACT FROM AUTHOR]

The use of buy now pay later (BNPL) services has grown rapidly in recent years. Existing research has considered the regulatory challenges they pose, but further work is required to map their significance as a means of normalizing and naturalizing debt. In response, this article focuses on the situated landscape of marketing and branding of BNPL services through analysis of their websites and apps, a walking ethnography of a large shopping centre, and interviews with BNPL customers. We find that BNPL services nurture a "structure of feeling" that is reminiscent of digitally intimate online spaces, and claim that by generating a sense of pleasure and fun they distinguish themselves from other comparatively "serious" financial services. We ultimately contend that this aids them in presenting themselves as simply a "way to pay" rather than a form of credit, arguing that this represents a significant new step in the depoliticization of debt. [ABSTRACT FROM AUTHOR]

Objectives: Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities. Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. Setting: Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. Participants: Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. Main outcome measures: Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. Results: Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. Conclusions: This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing. [ABSTRACT FROM AUTHOR]

The Australian disability workforce has grown, and there is compelling evidence that peer work has a number of valuable impacts. Despite these apparent opportunities, there continue to be high levels of unemployment among people with disability and failure to draw on the assets of people with disability in Australian workplaces. To understand these ostensible missed opportunities, this study examined the ways in which lived experience was described as an asset in disability workforce recruitment. Advertisements for positions in New South Wales, Australia, that referred to lived experience or peer work and disability were collected over a 3‐month period. Through a process of content analysis, we found that there were more employment opportunities for people with lived experience of mental illness than for other types of disability. Community engagement was a key function, and peer workers were described as complementary to professionals. Recruitment processes for lived experience jobs were not necessarily accessible. We recommend systemic reforms to facilitate recognition of lived experience as a valuable criterion for disability sector employment and to harness the benefits of a disability peer workforce. [ABSTRACT FROM AUTHOR]

Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such 'empowerment' through CAM use is often theorised as reflecting wider neoliberal imperatives of self‐responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self‐knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio‐recorded consultations and interviews with CAM practitioners to explore knowledge use in client‐practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner‐client dyad by introducing the concept of the 'salutogenic gaze'. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert. [ABSTRACT FROM AUTHOR]

Research on imitation in infancy has primarily focused on "what" and "when" infants imitate. More recently, however, the question why infants imitate has received renewed attention, partly motivated by the finding that infants sometimes selectively imitate the actions of others and sometimes faithfully imitate, or overimitate, the actions of others. The present study evaluates the hypothesis that this varying imitative behavior is related to infants' social traits. To do so, we assessed faithful and selective imitation longitudinally at 12 and 15 months, and extraversion at 15 months. At both ages, selective imitation was dependent on the causal structure of the act. From 12 to 15 months, selective imitation decreased while faithful imitation increased. Furthermore, infants high in extraversion were more faithful imitators than infants low in extraversion. These results demonstrate that the onset of faithful imitation is earlier than previously thought, but later than the onset of selective imitation. The observed relation between extraversion and faithful imitation supports the hypothesis that faithful imitation is driven by the social motivations of the infant. We call this relation the King Louie Effect: like the orangutan King Louie in "The Jungle Book," infants imitate faithfully due to a growing interest in the interpersonal nature of interactions.

This series focuses on aspects of prescribing for neonates, children and young people, from A–Z. Aspects of pharmacokinetics will be considered, alongside legal considerations, consent and medications in schools [ABSTRACT FROM AUTHOR]

Previous studies have reported that infants selectively reproduce observed actions and have argued that this selectivity reflects understanding of intentions and goals, or goal-directed imitation. We reasoned that if selective imitation of goal-directed actions reflects understanding of intentions, infants should demonstrate stability across perceptually and causally dissimilar imitation tasks. To this end, we employed a longitudinal within-participants design to compare the performance of 37 infants on two imitation tasks, with one administered at 13 months and one administered at 14 months. Infants who selectively imitated goal-directed actions in an object-cued task at 13 months also selectively imitated goal-directed actions in a vocal-cued task at 14 months. We conclude that goal-directed imitation reflects a general ability to interpret behavior in terms of mental states. (Contains 1 figure and 1 table.)

Introduction: Down syndrome (DS) is associated with immune dysregulation and a high risk of early onset Alzheimer's disease (AD). Complement is a key part of innate immunity and driver of pathological inflammation, including neuroinflammation in AD. Complement dysregulation has been reported in DS; however, the pattern of dysregulation and its relationship to AD risk is unclear. Methods: Plasma levels of 14 complement biomarkers were measured in 71 adults with DS and 46 controls to identify DS‐associated dysregulation; impact of apolipoprotein E (APOE) ε4 genotype, single nucleotide polymorphisms (SNPs) in CLU and CR1, and dementia on complement biomarkers was assessed. Results: Plasma levels of complement activation products (TCC, iC3b), proteins (C1q, C3, C9), and regulators (C1 inhibitor, factor H, FHR4, clusterin) were significantly elevated in DS versus controls while FI and sCR1 were significantly lower. In DS with AD (n = 13), C3 and FI were significantly decreased compared to non‐AD DS (n = 58). Neither APOE genotype nor CLU SNPs impacted complement levels, while rs6656401 in CR1 significantly impacted plasma sCR1 levels. Conclusions: Complement is dysregulated in DS, likely reflecting the generalized immune dysregulation state; measurement may help identify inflammatory events in individuals with DS. Complement biomarkers differed in DS with and without AD and may aid diagnosis and/or prediction. Highlights: Complement is significantly dysregulated in plasma of people with DS who show changes in levels of multiple complement proteins compared to controls.People with DS and dementia show evidence of additional complement dysregulation with significantly lower levels of C3 and factor I compared to those without dementia.rs6656401 in CR1 was associated with significantly elevated sCR1 plasma levels in DS. [ABSTRACT FROM AUTHOR]

In this article, we use a collaborative approach to autoethnography to explore experiences of power in relation to our identities as people with disabilities and/or mental illnesses. We draw on elements of Bronfenbrenner's ecological systems framework to consider how we enact our own power or struggle against systemic power in making meaning of our lives. As a team of lived experience researchers we wrote, shared and thematically analysed a series of narratives about our personal (microsystem) and institutional (macrosystem) relationships. Through this research process we were able to identify common experiences of being resilient in the face of institutions that dehumanised and problematised us and tried to render us voiceless—exerting 'power over'. In contrast, reflections on our personal relationships highlighted experiences of reciprocity, respect and autonomy that energised our efforts towards meaningful and powerful identities—'power with'. We conclude that by generating strength through our own advocacy, perseverance and caring relationships, we engage dynamics (mesosystem) of empowerment and identity to resist oppressive power at structural levels. This exemplifies the importance of person-centred social work premised on self-determination, autonomy and dignity, and socially just social work that advocates for equitability and fights structural discrimination. [ABSTRACT FROM AUTHOR]

Background: Reducing avoidable healthcare-associated harm is a global health priority. Progress in evaluating the burden and aetiology of avoidable harm in prisons is limited compared with other healthcare sectors. To address this gap, this study aimed to develop a definition of avoidable harm to facilitate future epidemiological studies in prisons. Methods: Using a sequential mixed methods study design we first characterised and reached consensus on the types and avoidability of patient harm in prison healthcare involving analysis of 151 serious prison incidents reported to the Strategic Executive Information System (StEIS) followed by in-depth nominal group (NG) discussions with four former service users and four prison professionals. Findings of the NG discussions and StEIS analysis were then synthesised and discussed among the research team and study oversight groups to develop an operational definition of avoidable harm in prison healthcare which was subsequently tested and validated using prison patient safety incident report data derived from the National Reporting and Learning System (NRLS). Results: Analysis of StEIS incident reports and NG discussions identified important factors influencing avoidable harm which reflected the unique prison setting, including health care delivery issues and constraints associated with the secure environment which limited access to care. These findings informed the development of a new working two-tier definition of avoidable harm using appropriate and timely intervention, which included an additional assessment of harm avoidability taking into the account the prison regime and environment. The definition was compatible with the NRLS incident report narratives and illustrated how the prison environment may influence identification of avoidable harm and judgements of avoidability. Conclusions: We have developed a working definition of avoidable harm in prison health care that enables consideration of caveats associated with prison environments and systems. Our definition enables future studies of the safety of prison healthcare to standardise outcome measurement. [ABSTRACT FROM AUTHOR]

Complement, a critical defence against pathogens, has been implicated as a driver of pathology in COVID‐19. Complement activation products are detected in plasma and tissues and complement blockade is considered for therapy. To delineate roles of complement in immunopathogenesis, we undertook the largest comprehensive study of complement in COVID‐19 to date, comprehensive profiling of 16 complement biomarkers, including key components, regulators and activation products, in 966 plasma samples from 682 hospitalized COVID‐19 patients collected across the hospitalization period as part of the UK ISARIC4C (International Acute Respiratory and Emerging Infection Consortium) study. Unsupervised clustering of complement biomarkers mapped to disease severity and supervised machine learning identified marker sets in early samples that predicted peak severity. Compared to healthy controls, complement proteins and activation products (Ba, iC3b, terminal complement complex) were significantly altered in COVID‐19 admission samples in all severity groups. Elevated alternative pathway activation markers (Ba and iC3b) and decreased alternative pathway regulator (properdin) in admission samples were associated with more severe disease and risk of death. Levels of most complement biomarkers were reduced in severe disease, consistent with consumption and tissue deposition. Latent class mixed modelling and cumulative incidence analysis identified the trajectory of increase of Ba to be a strong predictor of peak COVID‐19 disease severity and death. The data demonstrate that early‐onset, uncontrolled activation of complement, driven by sustained and progressive amplification through the alternative pathway amplification loop is a ubiquitous feature of COVID‐19, further exacerbated in severe disease. These findings provide novel insights into COVID‐19 immunopathogenesis and inform strategies for therapeutic intervention. [ABSTRACT FROM AUTHOR]

The importance of collaborative practice between those who provide services to children with special educational needs is now regarded as essential and is supported strongly by the UK government. However, joint working is often difficult to implement, despite the goodwill of all involved. This paper describes a pilot study aimed at developing collaboration between a local education authority and a National Health Service (NHS) Trust. It reports on the results of the evaluation and discusses aspects of the project that facilitated collaborative working between the various parties involved. (Contains 3 tables.)

Severe bacterial or viral infections can induce a state of immune hyperactivation that can culminate in a potentially lethal cytokine storm. The classic example is toxic shock syndrome, a life-threatening complication of Staphylococcus aureus or Streptococcus pyogenes infection, which is driven by potent toxins known as superantigens (SAgs). SAgs are thought to promote immune evasion via the promiscuous activation of T cells, which subsequently become hyporesponsive, and act by cross-linking major histocompatibility complex class II molecules on antigen-presenting cells to particular β-chain variable (TRBV) regions of αβ T cell receptors (TCRs). Although some of these interactions have been defined previously, our knowledge of SAg-responsive TRBV regions is incomplete. In this study, we found that CD4+ and CD8+ T cells expressing TRBV12-3/12-4+ TCRs were highly responsive to streptococcal pyrogenic exotoxin C (SpeC) and toxic shock syndrome toxin-1 (TSST-1). In particular, SpeC and TSST-1 specifically induced effector cytokine production and the upregulation of multiple coinhibitory receptors among TRBV12-3/12-4+ CD4+ and CD8+ memory T cells, and importantly, these biological responses were dependent on human leukocyte antigen (HLA)-DR. Collectively, these data provided evidence of functionally determinative and therapeutically relevant interactions between SpeC and TSST-1 and CD4+ and CD8+ memory T cells expressing TRBV12-3/12-4+ TCRs, mediated via HLA-DR. In peripheral blood mononuclear cells from healthy human donors, the superantigens SpeC and TSST-1 are shown to specifically activate TRBV12-3/12-4+ memory T cells. [ABSTRACT FROM AUTHOR]

This article explores collaborative autoethnography as a research method with emancipatory and unifying potential. We undertake this exploration via our shared stories of transitioning to adulthood through the lenses of identifying as living with and without disabilities. The article offers two important contributions: a deeper understanding of the ways in which disability identities relate to experiences of adulthood; and insights into the ways in which caring and collaborative autoethnographic methods can be applied in lived experience research. We found that adult identities were formed through acts of resistance and transitions to new relationships that exemplified a social relational model of disability. We found that collaborative autoethnography can be a valuable method for lived experience research that challenges power dynamics and subjectivities. A safe space in which researchers balance vulnerability and strengths can bring joy to research, even amidst the sharing of difficult stories. [ABSTRACT FROM AUTHOR]

Context Differences of sex development (DSD) represent a wide range of conditions presenting at different ages to various health professionals. Establishing a diagnosis, supporting the family, and developing a management plan are important. Objective We aimed to better understand the presentation and prevalence of pediatric DSD. Methods A retrospective, observational cohort study was undertaken in a single tertiary pediatric center of all children and young people (CYP) referred to a DSD multidisciplinary team over 25 years (1995-2019). In total, 607 CYP (520 regional referrals) were included. Data were analyzed for diagnosis, sex-assignment, age and mode of presentation, additional phenotypic features, mortality, and approximate point prevalence. Results Among the 3 major DSD categories, sex chromosome DSD was diagnosed in 11.2% (68/607) (most commonly 45,X/46,XY mosaicism), 46,XY DSD in 61.1% (371/607) (multiple diagnoses often with associated features), while 46,XX DSD occurred in 27.7% (168/607) (often 21-hydroxylase deficiency). Most children (80.1%) presented as neonates, usually with atypical genitalia, adrenal insufficiency, undescended testes or hernias. Those presenting later had diverse features. Rarely, the diagnosis was made antenatally (3.8%, n = 23) or following incidental karyotyping/family history (n = 14). Mortality was surprisingly high in 46,XY children, usually due to complex associated features (46,XY girls, 8.3%; 46,XY boys, 2.7%). The approximate point prevalence of neonatal referrals for investigation of DSD was 1 in 6347 births, and 1 in 5101 overall throughout childhood. Conclusion DSD represent a diverse range of conditions that can present at different ages. Pathways for expert diagnosis and management are important to optimize care. [ABSTRACT FROM AUTHOR]