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There has been a 70% increase in infant A&E attendance across England in the last decade, much of it non-urgent, highlighting the need to improve parental confidence and services for infant care. A multidisciplinary group of healthcare professionals was established with the aim of understanding and evaluating the support given to new parents in the early postnatal period. We recruited parents and caregivers of infants born in a large district hospital. Participants were recruited in the postnatal ward and neonatal unit. Participants were offered face-to-face or virtual interviews with an interpreter where required. Seventeen semi-structured interviews were conducted between February and September 2022 (16 virtual, 1 face-to-face). Thematic content analysis was used to manually identify codes and refined to develop a common coding framework which was used to identify final themes and subthemes. Following the initial set of interviews, a focus group with 12 different participants was held to validate the themes. Two main themes were identified: (1) service access, continuity, consistency, and personalisation of care are highly valued, and (2) preparation and support during transition is important and individual. Within theme 1, we identified facilitators (health literacy, consistent messaging, telephone line), barriers (staff shortages, communication between healthcare workers, discrimination), and person-centred care as sub-themes. In theme 2, participants highlighted the importance of their expectations of normal, support from family and friends, and experiences using applications and social media. Effective support and care in the postnatal period are vital for ensuring and promoting the health and wellbeing of mothers and their babies. These findings were presented to local maternity services and service users by the research team, resulting in local service improvements.

AbstractObjectiveTo evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings.DesignProspective study of three independent consecutive patient populations presenting to emergency departments.SettingSecondary and tertiary care hospitals in the United Kingdom and United States.ParticipantsHigh sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631). The final diagnosis of type 1 or type 2 myocardial infarction or myocardial injury was independently adjudicated.Main outcome measuresPositive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction.ResultsCardiac troponin concentrations were elevated in 13.7% (144/1054) of unselected patients, with a prevalence of 1.6% (17/1054) for type 1 myocardial infarction and a positive predictive value of 11.8% (95% confidence interval 7.0% to 18.2%). In selected patients, in whom troponin testing was guided by the attending clinician, the prevalence and positive predictive value were 14.5% (843/5815) and 59.7% (57.0% to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US. Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease.ConclusionsWhen high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction.

Management zones (MZs) are a key precision agriculture strategy for managing spatial variability in crops, but conventional delineation methods are costly, time-consuming, and rely on specialized equipment. Previous studies in potato production have primarily relied on single-year NDVI or proximal soil sensor data analyses, limiting their ability to capture temporal stability and variability across multiple fields. This study addresses this gap by applying multi-year, multi-source NDVI composites to characterize spatial and temporal patterns of agricultural potential across 17 commercial potato fields at McCain’s Farm of the Future, Florenceville-Bristol, New Brunswick. A total of 230 NDVI images from Sentinel-2 and Landsat 8 (2015–2023) were processed into composite metrics (mean, standard deviation, skewness) to delineate three agricultural potential (AP) MZs. Validation was conducted using 2023 potato tuber yield and soil physicochemical properties. The results showed statistically significant correlations between NDVI metrics and key soil nutrients (total carbon: |r| < 0.19; total nitrogen: |r| < 0.28), with tuber yield (|r| < 0.41). Spatial patterns of total carbon and nitrogen corresponded with delineated MZs, and tuber yield variability partially aligned with these zones. These findings demonstrate that multi-year NDVI composites provide a cost-effective and scalable approach for mapping agricultural potential, capturing both spatial and temporal variability, and supporting data-driven management decisions in potato production systems.

ObjectivesDespite improvement in the general health status of children, there has been an increase in children using primary, secondary and emergency healthcare (ED).1 In particular, infant ED visits have risen by nearly 4% annually from 2007 to 2017, with up to 40% of these visits being non-urgent 2 3;straining emergency departments and contributing to longer wait times. Socioeconomic status, language ability, and family support are all contributing factors. Postnatal care is primarily provided by midwives and health visitors, but challenges in continuity and communication exist as identified in the Ockenden Review, emphasising the importance of listening to families.This study aims to explore parental experiences of postnatal care and support and suggestions for current service improvement and re-design.MethodsOpportunistic and purposive sampling was used to recruit new parents and caregivers of infants born at a London Hospital between December 2021 and September 2022. Sixteen interviews were conducted between February and September 2022. Data was analysed thematically. A focus group with twelve parents validated interview themes and explored avenues for service enhancement. Illustrative quotations are presented.ResultsThe study identified three key themes:Poor access to healthcare services and professionals,‘The health visitor came to see us only one time and then she never called back and that’s it’. ‘I can’t call the GP… no appointment available for next three weeks’.The significance of continuity of care for parents,‘Just having a different midwife every eight hours and having to re explain everything was quite difficult and I found that stressful to the point where I was like, I’m not doing this anymore.’The impact of healthcare professionals’ attitudes, including concerns about discrimination based on ethnicity or language barriers,‘Discrimination, because we actually from other country, we are immigrants.’(Via a translator) ‘She says her husband speak English and they speak more with her husband.’ These findings highlight the need for improved access and continuity of postnatal care and the elimination of disparities in healthcare services.ConclusionThis study examines the crucial role of postnatal support and care for the well-being of mothers and babies in the UK. As a direct result of this study local changes have been made including: a commitment from maternity services to address continuity of care, re-instating a maternity telephone advice hotline, cultural competency training and funding was received to set up a wrap-around support service in the community for parents.ReferencesRuzangi J, Blair M, Cecil E, et al. Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017. BMJ Open. 2020;10(5):e033761. doi:10.1136/bmjopen-2019-033761.Simpson RM, O’Keeffe C, Jacques RM, Stone T, Hassan A, Mason SM. Non-urgent emergency department attendances in children: a retrospective observational analysis. Emergency Medicine Journal. 2022;39(1):17–22. doi:10.1136/emermed-2021-211431.Nicholson E, McDonnell T, de Brún A, et al. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare – systematic review. BMC Health Serv Res. 2020;20(1):663. doi:10.1186/s12913-020-05527-5.

Although Pakistan has rich biodiversity, many groups are poorly known, particularly insects. To address this gap, we employed DNA barcoding to survey its insect diversity. Specimens obtained through diverse collecting methods at 1,858 sites across Pakistan from 2010–2019 were examined for sequence variation in the 658 bp barcode region of the cytochrome c oxidase 1 (COI) gene. Sequences from nearly 49,000 specimens were assigned to 6,590 Barcode Index Numbers (BINs), a proxy for species, and most (88%) also possessed a representative image on the Barcode of Life Data System (BOLD). By coupling morphological inspections with barcode matches on BOLD, every BIN was assigned to an order (19) and most (99.8%) were placed to a family (362). However, just 40% of the BINs were assigned to a genus (1,375) and 21% to a species (1,364). Five orders (Coleoptera, Diptera, Hemiptera, Hymenoptera, Lepidoptera) accounted for 92% of the specimens and BINs. More than half of the BINs (59%) are so far only known from Pakistan, but others have also been reported from Bangladesh (13%), India (12%), and China (8%). Representing the first DNA barcode survey of the insect fauna in any South Asian country, this study provides the foundation for a complete inventory of the insect fauna in Pakistan while also contributing to the global DNA barcode reference library.

Intellectual disability (ID) and autism spectrum disorder (ASD) are neurodevelopmental disorders that have become a primary clinical and social concern, with a prevalence of 2–3% in the population. Neuronal function and behaviour undergo significant malleability during the critical period of development that is found to be impaired in ID/ASD. Human genome sequencing studies have revealed many genetic variations associated with ASD/ID that are further verified by many approaches, including many mouse and other models. These models have facilitated the identification of fundamental mechanisms underlying the pathogenesis of ASD/ID, and several studies have proposed converging molecular pathways in ASD/ID. However, linking the mechanisms of the pathogenic genes and their molecular characteristics that lead to ID/ASD has progressed slowly, hampering the development of potential therapeutic strategies. This review discusses the possibility of recognising the common molecular causes for most ASD/ID based on studies from the available models that may enable a better therapeutic strategy to treat ID/ASD. We also reviewed the potential biomarkers to detect ASD/ID at early stages that may aid in diagnosis and initiating medical treatment, the concerns with drug failure in clinical trials, and developing therapeutic strategies that can be applied beyond a particular mutation associated with ASD/ID.

The Fragile-X Mental Retardation Protein (FMRP) is an RNA binding protein that regulates translation of mRNAs essential for synaptic development and plasticity. FMRP interacts with a specific set of mRNAs, aids in their microtubule-dependent transport and regulates their translation through its association with ribosomes. However, the biochemical role of FMRP’s domains in forming neuronal granules and associating with microtubules and ribosomes is currently undefined. We report that the C-terminus domain of FMRP is sufficient to bind to ribosomes akin to the full-length protein. Furthermore, the C-terminus domain alone is essential and responsible for FMRP-mediated neuronal translation repression. However, dendritic distribution of FMRP and its microtubule association is favored by the synergistic combination of FMRP domains rather than individual domains. Interestingly, we show that the phosphorylation of hFMRP at Serine-500 is important in modulating the dynamics of translation by controlling ribosome association. This is a fundamental mechanism governing the size and number of FMRP puncta that contain actively translating ribosomes. Finally through the use of pathogenic mutations, we emphasize the hierarchical contribution of FMRP’s domains in translation regulation.

Twenty-nine species are treated, most of which have host caterpillar and food plant records, and all but one are new to science. The first host record for the agathidine genus Amputoearinus is given. Gnathopleura josequesadai Sharkey, sp. nov. is reported as a hyperparasitoid of fly larvae, the first such record for the genus. The following new species are diagnosed primarily using COI barcode data; Sharkey is the authority for all: Agathidinae: Aerophilus davidwagneri, Aerophilus fundacionbandorum, Aerophilus nicklaphami, Lytopylus davidstopaki, Lytopylus davidschindeli ; Alysiinae: Gnathopleura josequesadai ; Braconinae: Bracon andreamezae, Bracon franklinpaniaguai, Bracon rafagutierrezi, Bracon guillermoblancoi, Bracon oscarmasisi, Bracon pauldimaurai, Bracon shebadimaurae, Sacirema karendimaurae ; Cheloninae: Chelonus minorzunigai ; Homolobinae: Homolobus stevestroudi ; Macrocentrinae: Macrocentrus michaelstroudi ; Orgilinae: Stantonia gilbertfuentesi ; Rhysipolinae: Rhysipolis stevearonsoni ; Rogadinae: Aleiodes kaydodgeae, Aleiodes kerrydresslerae, Aleiodes josesolanoi, Aleiodes juniorporrasi, Aleiodes rocioecheverri, Aleiodes ronaldzunigai, Choreborogas jesseausubeli, Triraphis doncombi , and Yelicones mayrabonillae .

Healthcare professionals have a duty to maintain basic life support (BLS) skills. This study aims to evaluate medical students' factual knowledge of BLS and the training they receive. A cross-sectional, closed-response questionnaire was distributed to the first- and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent's previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions (MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identified answer to the 5 MCQ's. A total of 3,732 complete responses were received from 21 medical schools. Eighty percent ( =2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a significant difference ( <0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ's compared to the first-year students except in identifying the correct depth of compressions required during CPR ( =0.095). Overall 10.3% (95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ's on BLS 9% of the first-year students ( =194) and 12% of the fourth-year students ( =190). On an institutional level the proportion of students answering all MCQ's correctly ranged from 2% to 54% at different universities. Eighty-one percent of students ( =3,031) wished for more BLS training in their curriculum. Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

IntroductionIn aortic stenosis (AS), characterisation of ventricular (LV) remodelling beyond left ventricular mass measurements is lacking. We sought to study the 3-dimensional (3D) geometric LV remodelling pattern in severe AS pre- and post-surgical aortic valve replacement (AVR), and compared it with hypertensive and healthy controls.MethodsNinety-one subjects (36 severe AS, 19 hypertension and 36 healthy controls) underwent cardiac magnetic resonance (CMR). 18 AS patients had a repeat CMR eight-month post-AVR. 3D meshes were reconstructed from the myocardial contours of the CMR cine images. Principle component analysis and linear discrimination analysis were used to derive shape coefficients.ResultsAS patients had a significant shift in LV axis and apex orientation towards the septum, and more spherical LV shape which were not seen in the hypertensive and healthy control groups. As expected severe AS was associated with thicker and larger LV compared to the other two groups. Post AVR, despite significant reduction in LV thickness and sphericity, interestingly the shift in the LV axis/orientation was unchanged/irreversible (Figure 1).Abstract 20 Figure 1A) Comparison between average LV shape in AS (blue), AS post-AVR (green), and controls (red). B) Overlying shape between AS (orange) and control (purple) showing shift of LV axis to septum. C) Overlying shape of AS post-AVR (orange) and healthy control (purple) showing focal dilatation in the postero-septal region post AVRConclusionSevere AS is characterised by unique remodelling pattern which is not reversible post AVR. The novel shape metrics that comprehensively quantify the LV morphology may be a potential marker for risk stratification in the management of AS.Conflict of Interestnone