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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]

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]

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]

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]

Why you should read this article: • To enhance your knowledge of the structure and functions of the renal system • To recognise some of the renal conditions that may be seen in children and to understand how these are managed • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article, the 15th and last in a series on the biological basis of child health, focuses on the renal system, in particular the kidneys. It provides an overview of their role, function, anatomy and physiology, and embryological development. The renal system has a crucial role in homeostasis, so renal function impairment can have wide-ranging and potentially serious consequences for a child's overall health. The article describes some of the common renal conditions seen in children and how these are managed. It explains how to interpret the results of renal function tests and urine sampling conducted to assess renal function and to investigate acute and chronic disease. [ABSTRACT FROM AUTHOR]

Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of innate and acquired immunity and the different types of immune response • To reflect on the importance of immunisations and how to explain it to parents • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article, the 14th in a series on the biological basis of child health, focuses on the immune system. It provides an overview of pathogens to which the human body is susceptible, some of the milestones in the embryological development of the immune system, and some of the mechanisms of innate and acquired immunity. The article explains the importance of immunisations and provides examples of immune system dysfunctions and autoimmune conditions that children may experience. It is essential that children's nurses have an understanding of how the immune system develops, how it is structured and how it functions, since such knowledge will be relevant in the care of a range of conditions where nurses need to explain infection, inflammation and immune processes to children and parents. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the structure and main functions of the skin • To understand the aetiology, manifestations and management of skin conditions commonly seen in children • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article, the 13th in a series on the biological basis of child health, focuses on the skin. The skin is the largest organ in the body and covers its whole outer surface, protecting it from external threats, assisting in retaining body fluids, eliminating waste products and regulating temperature. The skin also has a crucial role in wound healing and vitamin D synthesis. Skin conditions in children are often distressing for children and parents, and may significantly affect their everyday lives. This article explains how the skin develops in utero, describes the structure and functions of the skin, and explores the aetiology, manifestations and management of skin conditions commonly seen in children. [ABSTRACT FROM AUTHOR]

The article explores the anatomy and pathophysiology of the endocrine system aimed to enhance the nurses' knowledge of this system, including its functioning and the conditions that young people are likely to experience when it malfunctions. Topics covered include the glands of the endocrine system and the hormones they secrete, the effects of hormones on normal functions of the human body, and the presentation and management of the most common endocrinopathies in children.

• Observed sensitivity was not predicted by parental gender or caregiver role. • Observed intrusiveness during play and feed was not predicted by parental gender or caregiver role. • Secondary caregiving fathers were more intrusive than secondary caregiving mothers while cleaning their infants. • Having twins was related to more intrusive behavior during play. The goal of our study was to examine whether differences in the sensitivity and intrusiveness of fathers and mothers from gay-, lesbian-, and heterosexual-parent families (57 French couples, 47 Dutch couples, and 31 British couples) with their first-born infants were explained by gender or caregiver role, while controlling for nesting within families, infant temperament, and twinship. We assessed the sensitivity and intrusiveness of 147 primary caregivers (45 fathers, 102 mothers) and 123 secondary caregivers (68 fathers and 55 mothers). All infants were conceived using assisted reproductive techniques and averaged 4 months of age. They were videotaped at home with both parents while engaged in play, feeding, and other childcare (bathing or changing) and these videotapes were coded for sensitivity and intrusiveness. Information about relative levels of caregiving, infant temperament, and twinship was collected via parent report questionnaires. Mixed linear models showed that sensitivity while playing, cleaning, and feeding were not predicted by parental gender, relative parental involvement, and the interaction between parental gender and parental caregiver role. Models for intrusiveness while playing and feeding showed similar results. However, intrusiveness during cleaning was predicted by parental gender and the interaction between parental gender and caregiver role. Post-hoc analyses showed that secondary caregiving fathers showed more intrusive behavior during cleaning (M = 1.51, SD = 0.09) than secondary caregiving mothers (M = 1.26, SD = 0.10). Our results also showed that contextual factors, such as having singletons or twins, infant temperament, and country of residence were related to parenting behavior. In sum, our findings do not support presumptions that mothers are more capable of providing better quality care than fathers, or that, at this early stage, primary caregiving parents are better attuned to their infants than those who are less involved. [ABSTRACT FROM AUTHOR]

Aims: Suicide prevention remains a priority in rural and remote Australia, where suicide rates continue to be higher than those in urban communities. This commentary describes the Good SPACE suicide prevention program, and the lessons learned from delivering this program over a 14‐year period. Context: The Good SPACE program has been operating in rural New South Wales since 2007. The program focuses on educating rural community members to recognise the signs of suicide vulnerability, and how to take appropriate action if they encounter someone considering suicide. Approach: Communities are selected to receive Good SPACE training in consultation with key stakeholder organisations, or by request from communities. Across the life of the program, key challenges in its administration have included short‐term funding arrangements and staff turnover. Strengths have included the ability to adapt content to meet the needs of rural communities (eg from an initial focus on helping farmers during periods of drought, to a broader focus on all rural residents and a wider range of adversities). As the program moves forward, emphasis will be placed on harder‐to‐reach populations, including males and those with lower mental health literacy. Conclusion: The Good SPACE program has ongoing funding to adapt its content and continue administration through the Rural Adversity Mental Health Program (https://www.ramhp.com.au/). The lessons learned throughout the life of the program might be of use to other organisations aiming to provide community‐based education programs in rural and remote communities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the anatomy, physiology and development of the five senses • To increase your awareness of the common childhood conditions that can affect sensory function • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article, the 11th in the Biological basis of child health series, focuses on the senses. There are five basic senses in humans: hearing, sight, touch, smell and taste. Several congenital and acquired conditions can affect the senses and may have significant negative effects on a child's development and ability to communicate with others. This article explores each of the five senses, discussing their anatomy, physiology and embryological development, as well as common conditions affecting sensory function in children. It aims to provide children's nurses with an understanding of the role of the senses in supporting children to make sense of the world, and how knowledge of this can be linked to clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article provides an overview of the embryological development of the liver and clinical features of childhood liver disease. It outlines characteristics of the liver's anatomy and explains functions of the liver including synthesis of the bile and coagulation factors and glucose generation. Information is provided on liver function tests, liver disease in children such as jaundice, biliary atresia, pruritus and hepatic encephalopathy, and developments in children's liver transplantation.

Why you should read this article: • To enhance your knowledge of the development of the gastrointestinal (GI) system • To understand the causes and management of various GI conditions that infants and children may present with • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article is the eighth in a series on the biological basis of child health. It describes the embryological development of the gastrointestinal (GI) system and some of the structural anomalies that may arise during that time and later affect GI functioning. The article also discusses the functions of the GI tract – including ingestion, digestion, absorption and defecation – and explains how these relate to GI conditions seen in infants and children. GI conditions are common in childhood and some of these will be medical emergencies, so it is important that children's nurses have knowledge of the GI system and of the presentation and management of GI conditions in children. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the stages of growth and developmental milestones in childhood • To enable you to understand various conditions that can affect growth and development in children • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article is the seventh in a series on the biological basis of child health. It describes early developmental milestones, stages of growth, puberty and the development of the reproductive system. It also outlines the methods used to assess growth and development, and describes conditions that affect growth and development in infants, children and young people. Understanding childhood growth and development is crucial for children's nurses, who need to be able to identify potential deviations from the norm, since these often reveal underlying conditions that require treatment. [ABSTRACT FROM AUTHOR]

Objective: This evaluation considered the potential of We‐Yarn, a suicide prevention gatekeeper training workshop, to contribute to Aboriginal suicide prevention in rural New South Wales. Design: A mixed methods approach included surveys, in‐depth interviews and workshop observations. Setting: Aboriginal suicide prevention training in rural New South Wales, Australia. Participants: Attendees at We‐Yarn training. Intervention: We‐Yarn provided culturally safe suicide prevention skills training for Aboriginal people and for those who work with Aboriginal communities and persons in rural New South Wales. Training workshops were delivered across multiple locations for 6 hours in one day. Workshops were facilitated by two facilitators with lived and professional experience; one Aboriginal and one non‐Aboriginal facilitator. We‐Yarn content was developed by staff from the Centre for Rural and Remote Mental Health, and in consultation with Aboriginal Elders and representatives of Aboriginal Medical Services to ensure relevance and cultural appropriateness. Main outcome measures: Pre and post‐workshop surveys captured capacity and participants' confidence in identifying and responding to a person at risk of suicide. Interviews explored participants' experiences of workshops, implementation of learning, and attitudes regarding social and emotional wellbeing and suicide. Observations detailed the workshop environment, participants' engagement, and participants' responses to facilitators and content. Results: We‐Yarn was considered culturally appropriate. Participants responded to facilitators' lived experiences. Participants reported significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention. However, health professionals with existing knowledge wanted a stronger focus on clinical training. Conclusion: We‐Yarn promoted discussion of suicide prevention within a holistic health framework, building on participants' pre‐existing knowledge about social and emotional wellbeing. Importantly, skilful facilitators with lived experience were vital to the success of the workshops. Consideration should be given to attracting people with low suicide prevention knowledge to the workshops, developing tailored workshops for health professionals and ensuring prolonged engagement with communities. Multifaceted and long term responses in addition to this type of training are important. [ABSTRACT FROM AUTHOR]

Differences in Sex Development (DSD) encompasses many diagnoses, where the development of chromosomal make-up, gonadal development or anatomical development is atypical. XY, DSD is a classification under the recent international consensus statement, and XY females commonly encapsulate disorders of androgen synthesis and androgen action. Complete Androgen Insensitivity Syndrome (CAIS) is the most common XY, DSD diagnosis, which results in an individual having XY chromosomes, but the person is phenotypically female. This article explores the care and management of children and young people with a DSD and focuses on the diagnosis of CAIS in adolescence. Medical and surgical management is discussed, alongside sexual function, gender identity and the psychological impact of the diagnosis. The involvement of the multidisciplinary team is stressed, together with an emphasis on the investment that is needed in psychological and nursing support for girls with CAIS, and their families. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To enhance your knowledge of the development of the respiratory system before and after birth • To understand the causes and management of various common respiratory conditions that infants and children may present with • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article is the fifth in a series on the biological basis of child health. It describes the development of the respiratory system, which starts relatively late in the embryo and continues after birth until the age of seven to eight years. It explains what the developing anatomy of the respiratory system in infants and children means in terms of the conditions that may occur and the precautions required when assessing them. The article provides an overview of the elements of respiratory assessment in infants and children and describes some respiratory conditions seen in these patient groups. It also discusses some of the changes in the care of children with respiratory conditions, which has increasingly moved from hospital into the community and become nurse-led, multidisciplinary and holistic. [ABSTRACT FROM AUTHOR]

Background: Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. Methods: Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15–49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. Results: Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff. Conclusion: Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options. [ABSTRACT FROM AUTHOR]

This article is the first of a series that outlines the fundamental aspects of the biological basis of child health. Cells and genes are the basic units of life. Therefore, it is essential that nurses have knowledge of how cells function to understand normal physiology and pathophysiology, and how specific conditions are inherited. This article describes the components of the human cell, detailing their structure and function. It also discusses genetics, providing examples of inherited diseases including those caused by mutations that affect specific components of the cell. The aim is to provide children's nurses with an accessible introduction to cell biology and genetics linked to their clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. Design: Data were gathered through a cross-sectional survey distributed by a social media boosted post. Setting: A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. Participants: A total of 765 adult, rural residents completed the survey. Main outcome measure(s): Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. Results: Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. Conclusions: Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness. [ABSTRACT FROM AUTHOR]

• Family inclusion in child protection is a critical but unrealised aim in Australia. • Parents who have had children removed from their care feel powerless and voiceless. • Parents seek collaboration and meaningful roles in their children's lives. • Parents' advocacy and passion can be reconceptualised as an asset for inclusion. The inclusion of families throughout the child protection process can improve lifelong outcomes for children who have been removed from their parents' care. However, child protection authorities have struggled to prioritize principles of family inclusion within systems that position families as risky. While parents' experiences of powerlessness within child protection systems have been well documented, little is known about parents' perspectives on family inclusion specifically. We engaged six parents who had experienced removal of children from their care in interviews and focus groups as part of a larger study that examined practitioners', carers', lawyers' and parents' views on family inclusion in Australia. In this article we report on parents' experiences and recommendations for improving family inclusion. Through the analytical framework of Foucauldian concepts of power, knowledge and acts of resistance we highlight the complexities of parents' lives and intersections in their experiences of systemic and social exclusion. In identifying the importance of collaboration, decision making and parental identity these findings suggest that the advocacy of parents for inclusion in the lives of their children is an underutilized asset in child protection systems. [ABSTRACT FROM AUTHOR]

• 60 MHz benchtop NMR spectroscopy of characteristic metabolites in saffron. • Machine learning models can detect samples with anomalous composition. • Multiple compromised products were found in survey of purchased samples. 60 MHz proton NMR spectroscopy was used to analyse extracts from saffron spice and a range of potential adulterants and mixtures. Using a simple extraction procedure, good quality spectra were obtained which contain peaks from the characteristic metabolites picrocrocin and crocins, fatty acids and kaempferol. The spectra of samples from trusted suppliers were used to train one-class classification models by SIMCA, nearest neighbour and isolation forest methods. Applying these to spectra of saffron samples purchased from the online marketplace, it was found that 7 out of 33 samples were highly anomalous. From comparison with the spectra of known mixtures and confirmatory spectral analysis using 600 MHz NMR, it is probable that these contain considerable amounts of undisclosed foreign matter. [ABSTRACT FROM AUTHOR]

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community-based mental health service This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community-based mental health service. Interviews with 19 peer and non-peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non-judgemental way. However, peer support workers tended to 'fill service gaps' within intensive, administrative case-management environments. These findings highlight the importance of an organisational-wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: • Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; • The roles of peer support workers were poorly understood by team members; • Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation. [ABSTRACT FROM AUTHOR]

Summary This article considers the place of service-user knowledge and expertise within an evidence-based practice perspective. It makes a strong argument that client involvement is a core principle of Sackett et al.'s foundational approach in evidence-based medicine. In so doing, it draws on research on service-users' perceptions and experiences of evidence-based practice. Findings For service users, evidence-based practice lacks relevance and trustworthiness unless it explicitly factors in the expertise of service users themselves. Evidence-based practice is seen to have merit as a tool for enhancing accountability, but service users see a role for themselves at individual and representative levels in the process of evidence-based practice. They place a high value on the expertise derived from lived experience, and recognise that fluctuations in capacity and changes in circumstances of many service users require a flexible approach to their participation in decision making. A pragmatic approach to the conceptualisation of evidence is recommended, which not only maintains scientific rigour inherent in evidence-based practice but also more strongly emphasises the process of analysing evidence appropriate to a particular individual's preferences and circumstances. Applications For human service practitioners, this study emphasises the need to develop professional skills in assessing the capacities, circumstances and preferences of clients and analysing and applying evidence for practice in ways that conform to a client-centred approach. It also indicates a need for researchers and practitioners to recognise and value service-user expertise. [ABSTRACT FROM AUTHOR]

Children and young people referred to paediatric endocrinology services present with a wide range of illnesses and disorders varying from minor to life-threatening conditions. This article introduces the role of the children's endocrine nurse in caring for children and families undergoing investigations that are frequently undertaken to identify specific problems associated with pituitary, adrenal and thyroid glands. Although children with endocrine problems may be cared for in specialist centres, they may also present, for other health reasons, in secondary and primary care. In schools some children may need teachers to administer emergency medication. There is a high incidence of children diagnosed with growth hormone deficiency and an even higher incidence of congenital hypothyroidism. These children would benefit from health professionals having a broader understanding of their conditions. This article - the third in the endocrinology nursing series - aims to disseminate information and educate colleagues in children's nursing to raise the profile of children with long-term endocrine conditions. [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]

A series of five substituted benzoic acids with 10 substituted pyridines and quinolines have been crystallized so that their ΔpKa, defined as pKa base-pKa acid, varied from -1.14 to +4.16. This spans the 'uncertainty' region for the formation of salt co-crystals. Although most of our results confirmed that structure formation of co-crystal salt parts at Δp a ≈ 2, we report here a structure that does not follow the general rule and serves as a cautionary tale. [ABSTRACT FROM AUTHOR]

Models of service-user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of 'parity of participation' as an appropriately multifaceted frame for capturing the social justice aspirations of service-user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity-based consumerist notions of participation to reify group identity. This leads to tokenistic service-user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service-user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service-user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service-user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced. [ABSTRACT FROM AUTHOR]

Abstract: 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 13months and one administered at 14months. Infants who selectively imitated goal-directed actions in an object-cued task at 13months also selectively imitated goal-directed actions in a vocal-cued task at 14months. We conclude that goal-directed imitation reflects a general ability to interpret behavior in terms of mental states. [Copyright &y& Elsevier]

In the present article, we introduce the continuous unified electronic (CUE) diary method, a longitudinal, event-based, electronic parent report method that allows real-time recording of infant and child behavior in natural contexts. Thirty-nine expectant mothers were trained to identify and record target behaviors into programmed handheld computers. From birth to 18 months, maternal reporters recorded the initial, second, and third occurrences of seven target motor behaviors: palmar grasp, rolls from side to back, reaching when sitting, pincer grip, crawling, walking, and climbing stairs. Compliance was assessed as two valid entries per behavior: 97 % of maternal reporters met compliance criteria. Reliability was assessed by comparing diary entries with researcher assessments for three of the motor behaviors: palmar grasp, pincer grip and walking. A total of 81 % of maternal reporters met reliability criteria. For those three target behaviors, age of emergence was compared across data from the CUE diary method and researcher assessments. The CUE diary method was found to detect behaviors earlier and with greater sensitivity to individual differences. The CUE diary method is shown to be a reliable methodological tool for studying processes of change in human development. [ABSTRACT FROM AUTHOR]

The reaction of 5-nitroisophthalic acid (H2NIA) with Gd(NO3)3·6H2O in DMF afforded three new metal-organic frameworks: [Gd(NIA)1.5(DMF)2]·DMF (I), [Gd2(NIA)3(DMF)4]· xH2O (II) and [Gd4(NIA)6(DMF)5.5(H2O)3]·4DMF·H2O (III). These compounds can be prepared through a variety of methods. Compounds (I) and (II) are more reproducibly formed than compound (III). Network analysis revealed (I) to have a (412.63)- pcu topology, while (II) displays a (42.84)(42.84)- pts topology. Compound (III) was found to present the uncommon 4,5,6T11 topological net, which combines aspects of both the pcu and pts topologies. The short symbol of this net is (44.62)(46.64)2(48.66.8). [ABSTRACT FROM AUTHOR]

The reaction of 1,3,5-benzenetricarboxylic acid (H3BTRI)with ZnSO4·7H2O in DMF and H2O afforded [Zn2(μ2-OH2)(HBTRI)(BTRI)(H2O)2]·DMA·3H2O (1). Compound 1displays self-healing properties upondehydration and rehydration as revealed by scanning electron microscopy.Further studies showed that 1is flexible and able toabsorb additional water molecules in high vapor pressure environments.The reaction of H3BTRI with Gd(NO3)3·6H2O in DMF and H2O resulted in [Gd(BTRI)(H2O)6] (2). It is also possible to formcompound 2through a solid-state process when crystalsof 1are placed into a solution of Gd(NO3)3·6H2O in DMF and H2O. The reverseprocess does not occur. [ABSTRACT FROM AUTHOR]

Postoperative or pressure alopecia (PA) is an infrequently reported group of scarring and non-scarring alopecias. It has been reported after immobilization of the head during surgery and following prolonged stays on intensive care units, and may be analogous to a healed pressure ulcer. This review presents a summary of cases published in pediatrics and after cardiac, gynecological, abdominal and facial surgeries. PA may manifest as swelling, tenderness, and ulceration of the scalp in the first few postoperative days; in other cases, the alopecia may be the presenting feature with a history of scalp immobilization in the previous four weeks. The condition may cause considerable psychological distress in the long term. Regular head turning schedules and vigilance for the condition should be used as prophylaxis to prevent permanent alopecia. A multi-center study in high-risk patients would be beneficial to shed further light on the etiology of the condition. [ABSTRACT FROM AUTHOR]

From the parent compound [Ca[Co(ethylenediamine)(oxalato)2]2]n·4H2O, 1, a series of framework compounds was prepared via the soluble sodium salt and crystal growth with the divalent metal ions Cd2+, Mn2+, and Sr2+, (2−4). These compounds have the same general formula [M[Co(ethylenediamine)(oxalato)2]2]n·xH2O, and they all form the same four- and eight-connected 3D net having scu topology (and are thus isoreticular) with water filled channels of variable size running in one direction of the crystals. However, they crystallize in two different space groups, the chiral P21 (3, 4, and the low temperature form of 1) and the noncentrosymmetric P4̅ (1 and 2). The potential voids upon water removal are 18−20% of the unit cell. Preliminary gas sorption measurements at 298 K and 8 bar show substantial CO2 and N2O uptake (12−14% and 15−16% by mass, respectively), while the H2 uptake was 0.18%, a relatively high value considering the low pressure and high temperature. A MOF series with formula [M[Co(en)(ox)2]2]n·4H2O, M = Ca2+, Cd2+, Mn2+, Sr2+ are presented. These form the same 3D scu-nets with water filled channels of variable size. For Ca2+ gas sorption (298 K, 8 bar) show CO2 and N2O uptake of 13% and 14% by mass, while H2 uptake was 0.18%, a relatively high value considering the pressure and temperature. [ABSTRACT FROM AUTHOR]

This article is a study of how Nottinghamshire Drug and Alcohol Action Team used Drug Intervention Programme monies to support partnership working in Nottinghamshire to secure supported housing for drug-using offenders who were fast-tracked into treatment by their involvement with the Criminal Justice System. The article identifies lessons learnt in relation to partnership engagement, community involvement and the importance of involving wrap-around services in holistic delivery of supported housing and treatment. It also identifies the ongoing challenges of meeting the needs of service users alongside those of housing providers, and looks at very quick wins in relation to housing for substance misusers from bond schemes and use of established debt advisors who can support individuals in their resettlement needs. [ABSTRACT FROM AUTHOR]

This paper reviews nine of the best-known strategies for eliminating and reducing substances in the category known as "persistent bioaccumulative toxic substances" (PBTSs). The nine strategies are as follows: 1) Ontario's Candidate Substances list for Bans and Phase-outs (1992), 2) Canada's ARET Program (1994), 3) Canada's Toxic Substances Management Policy (1995), 4) the Commission for Environmental Cooperation's Sound Management of Chemicals Initiative (1995), 5) the Great Lakes Binational Toxics Strategy (1997), 6) the U.S. Environmental Protection Agency's (U.S. EPA's) draft National PBT Strategy (1998), 7) U.S. EPA's Waste Minimization Program (1998), 8) the U.N. Stockholm Convention on Persistent Organic Pollutants (2001), and 9) Washington State's Rule on Persistent Bioaccumulative Toxins (2006). The review describes the commonalities among the strategies, including their goals and principles, design approaches, and other common elements. It also discusses several emerging trends, such as the increasing importance of economic considerations, human health information, and nonregulatory management approaches. The paper concludes with a discussion of how effective the strategies have been at achieving their goals of elimination and reduction of persistent bioaccumulative toxic substances. [ABSTRACT FROM AUTHOR]

This article looks at the literary association of two eighteenth-century women, one British, one American, during the decades that surrounded the Revolutionary War. Catharine Macaulay and Mercy Otis Warren are best known as historians, but this article argues for the importance of their letters and suggests a way of reading their correspondence in terms of the distinction Jürgen Habermas makes between literary and political public spheres in his Structural Transformation of the Public Sphere . The author traces Macaulay and Warren's different situations within their particular republican milieus, and suggests how a language of feeling and the space of the letter might afford an important forum for transatlantic debate on women's literary and political identities. The article concludes by discussing Macaulay and Warren's correspondence in the broader context of women's letters in the Anglo-American Atlantic. [ABSTRACT FROM AUTHOR]

In vitro monocyte-derived macrophages (MDMac) and synovial fluid macrophages from inflamed joints differ from monocytes in their responses to interleukin 4 (IL-4). While IL-4 can suppress LPS-induced interleukin β (IL-β) and tumour necrosis factor α (TNF-α) production by monocytes, IL-4 can suppress LPS-induced IL-1β, but not TNFα production by the more differentiated cells. Recently we reported a correlation between the ability of IL-4 to regulate TNFα production by monocytes and the expression of the IL-4 receptor gamma chain or gamma common (γc chain). Like MDMac, interferon α (IFNα)-treated monocytes expressed less IL-4 receptor γc chain, reduced levels of IL-4-activated STAT6 and IL-4 could not suppress LPS-induced TNFα production. In addition, like monocytes and MDMac, IFNα-treated monocytes expressed normal levels of the IL-4 receptor α chain and IL-4 significantly suppressed LPS-induced IL-1β production. With addition of IFNα-neutralizing antibodies, the ability of IL-4 to suppress LPS-induced TNFα production with prolonged monocyte culture was restored. Detection of IFNα in synovial fluids from inflamed joints further implicates IFNα in the inability of IL-4 to suppress TNFα production by synovial fluid macrophages. This study identifies a mechanism for the differential expression of γc and varied responses to IL-4 by human monocytes compared with MDMac. [Copyright &y& Elsevier]

Indigenous women's health in low and middle-income countries continues to experience exclusions from the mainstream context and has remained underrepresented in health research, including qualitative research. Based on mixed methods research (comprising qualitative and quantitative methods) into Indigenous women in Bangladesh, this article addresses the reflexivity of a non-Indigenous researcher studying Indigenous women's health issues in the Chittagong Hill Tracts of Bangladesh. As reflexivity is a crucial strategy to ensure rigor in qualitative research, understanding how the characteristics and experiences of the study may influence the research process is of paramount importance. For non-Indigenous researchers working in an Indigenous context, the imperative to understand one's impact and position within the research becomes even more critical. Unfortunately, non-Indigenous researchers often avoid providing appropriate detail on reflexivity aspects in conducting research, particularly mixed-method research, among Indigenous communities in low- and middle-income countries like Bangladesh. In this reflexive evaluation, the researchers of this mixed method study evaluate the introspective reflexivity; reflect on the pre-research stage in developing collaborative and negotiated design and reflect on positionality during fieldwork and data analysis to consider interpersonal and collective dynamics during the research process. Strategies are offered to harvest the benefits of the researcher's familiarity with the subject and limit any unfavorable consequences. Directions for future research include integration of research methods, using qualified Indigenous researchers, engaging Indigenous community leaders, and collecting data using native language to respect and value the culture and voice of Indigenous communities. [ABSTRACT FROM AUTHOR]

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]

The article focuses on the composition, functions and formation of blood and common blood disorders in children. It outlines the embryonic development of blood cells, occurrence of haemopoiesis and blood count values for different age groups. It explains signs and symptoms, causes and risks for and effects of low blood cell counts on children. Information is provided on blood groups, blood transfusions and disorders such as anaemia, sickle cell disease, clotting, haemophilia and blood cancer.

This article is the sixth in a series on the biological basis of child health. It provides an overview of the development of the skeletal system before and after birth, and outlines the potential congenital anomalies that may occur. The article explains the structure and function of the bones before describing the role of the joints, tendons and ligaments. It also outlines the presentation and management of some of the common orthopaedic conditions seen in infants and children, including fractures, osteogenesis imperfecta, scoliosis, juvenile idiopathic arthritis, developmental dysplasia of the hip and achondroplasia. [ABSTRACT FROM AUTHOR]

Background: Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. Methods: Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). Results: Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16–29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48–0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1–4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4–8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6–8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1–8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1–11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6–16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7–25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1–7.4). Conclusion: Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored. [ABSTRACT FROM AUTHOR]