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This article presents three case studies of patients that a child and adolescent mental health service (CAMHS) have supported and its purpose is to encourage discussion of two key learning points. The first of these is the utility of developmental trauma as an approach for children with mental health presentations. The second centres on the importance of multi-agency working when working with young people, principally those within the UK's local authority care system (‘looked after children’), who have had traumatic experiences in order to enhance positive outcomes. We also want to encourage consideration of the implications of developmental trauma for current core CAMHS therapeutic models in an attempt to reach beyond the often held narrative that the trauma formulation implies there is ‘just trauma, no mental illness’.

Why did you do this work?Assess the use of HEEADSSSS assessments1 in an acute paediatrics department in a district general hospital (DGH)Understand the context of when clinical staff are performing HEEADSSSS assessments in this setting to identify barriers to increasing use of the assessmentWhat did you do?This was a two-stage study.In the first stage we looked at 30 patient records aged from 10-16 years old. These were prospectively selected at random from patients seen on the children’s assessment unit and ward. Any patients seen by the audit team were excluded. We assigned 17 points for any mention across documentation for the whole admission for certain components and sub-components of the HEEADSSSS assessment. We also recorded if they had been seen alone and whether confidentiality had been discussed.The second phase involved a survey to assess clinician thinking around HEEADSSSS assessments. We explored several domains with particular focus on; when clinicians would initiate an assessment, which aspects made them feel more or less comfortable, and finally why clinicians were more or less comfortable with these aspects.What did you find?For stage one the average age was 12.5 years. There were many reasons for admission. Two presented with overdose, and all others had presented with complaints related to physical symptoms. Only 2 patients seen had formally documented HEEADSSSS assessments, and the average score was 2.67 out of 17. The study was limited by a small sample size and small adolescent patient volume.In the second stage we had 38 respondents to the survey, with a range of healthcare professionals including consultants, registrars, GPSTs, nurses and foundation doctors. The average age of respondents was 35.3 years, on average people felt 3.2 out of 5 regarding level of knowledge (with 5 being expert). A range of perceived age and indication criteria were given. Core themes that made people uncomfortable about performing HEEADSSS assessments included:Concern around ‘planting seeds’Risk of breakdown of relationship if questions didn’t seem relevantLimited experience of HEEADSSSSLack of knowledge on subsections i.e. LGBTQ+ terminologyFeeling unsure what to do with information i.e. what to do if a young person feels suicidalWhat does it mean?This audit demonstrated that the HEEADSSSS screening tool is not being used in keeping with guidance at our hospital. Through the survey we have identified teaching and education around this assessment is a key area that requires improvement and moving forward we have developed example question cards as part of our paediatric flipcards, a new induction video that we would like to share as part of the conference and simulation sessions for rotational trainees.ReferenceHEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Cohen, Eric et al. Journal of Adolescent Health, Volume 12, Issue 7, 539 – 544

Why did you do this work?Assess the use of HEEADSSSS assessments1 in an acute paediatrics department in a district general hospital (DGH)Understand the context of when clinical staff are performing HEEADSSSS assessments in this setting to identify barriers to increasing use of the assessmentWhat did you do?This was a two-stage study.In the first stage we looked at 30 patient records aged from 10-16 years old. These were prospectively selected at random from patients seen on the children’s assessment unit and ward. Any patients seen by the audit team were excluded. We assigned 17 points for any mention across documentation for the whole admission for certain components and sub-components of the HEEADSSSS assessment. We also recorded if they had been seen alone and whether confidentiality had been discussed.The second phase involved a survey to assess clinician thinking around HEEADSSSS assessments. We explored several domains with particular focus on; when clinicians would initiate an assessment, which aspects made them feel more or less comfortable, and finally why clinicians were more or less comfortable with these aspects.What did you find?For stage one the average age was 12.5 years. There were many reasons for admission. Two presented with overdose, and all others had presented with complaints related to physical symptoms. Only 2 patients seen had formally documented HEEADSSSS assessments, and the average score was 2.67 out of 17. The study was limited by a small sample size and small adolescent patient volume.In the second stage we had 38 respondents to the survey, with a range of healthcare professionals including consultants, registrars, GPSTs, nurses and foundation doctors. The average age of respondents was 35.3 years, on average people felt 3.2 out of 5 regarding level of knowledge (with 5 being expert). A range of perceived age and indication criteria were given. Core themes that made people uncomfortable about performing HEEADSSS assessments included:Concern around ‘planting seeds’Risk of breakdown of relationship if questions didn’t seem relevantLimited experience of HEEADSSSSLack of knowledge on subsections i.e. LGBTQ+ terminologyFeeling unsure what to do with information i.e. what to do if a young person feels suicidalWhat does it mean?This audit demonstrated that the HEEADSSSS screening tool is not being used in keeping with guidance at our hospital. Through the survey we have identified teaching and education around this assessment is a key area that requires improvement and moving forward we have developed example question cards as part of our paediatric flipcards, a new induction video that we would like to share as part of the conference and simulation sessions for rotational trainees.ReferenceHEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Cohen, Eric et al. Journal of Adolescent Health, Volume 12, Issue 7, 539 – 544

Background Gene copy number variation plays a large role in the evolution of genomes. In Rattus norvegicus and other rodent species, the Y-chromosome has accumulated multiple copies of Sry loci. These copy number variations have been previously linked with changes in phenotype of animal models such as the spontaneously hypertensive rat (SHR). This study characterizes the Y-chromosome in the Sry region of Rattus norvegicus , while addressing functional variations seen in the Sry protein products. Results Eleven Sry loci have been identified in the SHR with one ( nonHMG Sry ) containing a frame shift mutation. The nonHMGSry is found and conserved in the related WKY and SD rat strains. Three new, previously unidentified, Sry loci were identified in this study ( Sry3BII , Sry4 and Sry4A ) in both SHR and WKY. Repetitive element analysis revealed numerous LINE-L1 elements at regions where conservation is lost among the Sry copies. In addition we have identified a retrotransposed copy of Med14 originating from spliced mRNA, two autosomal genes ( Ccdc110 and HMGB1 ) and a normal mammalian Y-chromosome gene ( Zfy ) in the Sry region of the rat Y-chromosome. Translation of the sequences of each Sry gene reveals eight proteins with amino acid differences leading to changes in nuclear localization and promoter activation of a Sry-responsive gene. Sry-β (coded by the Sry2 locus) has an increased cytoplasmic fraction due to alterations at amino acid 21. Sry-γ has altered gene regulation of the Sry1 promoter due to changes at amino acid 76. Conclusions The duplication of Sry on the Rattus norvegicus Y-chromosome has led to proteins with altered functional ability that may have been selected for functions in addition to testis determination. Additionally, several other genes not normally found on the Y-chromosome have duplicated new copies into the region around the Sry genes. These suggest a role of active transposable elements in the evolution of the mammalian Y-chromosome in species such as Rattus norvegicus.

Why did you do this work?To improve undergraduate medical students’ confidence and knowledge in performing the Newborn Infant Physical Examination (NIPE). To provide teaching opportunities to foundation doctors (FDs) in a district general hospital.What did you do?Sessions on how to perform the NIPE were delivered by four FDs rotating through the King’s Mill Hospital paediatric department. This was with the supervision of Dr Bains, the trust Child Health education lead, who shadowed the first two sessions to ensure appropriate supervision. These sessions ran over 2 years for 10 cohorts of medical students. In phase 1 (November 2022 -June 2023), 55 students were taught. In phase 2 (March 2024-July 2024) 72 students were taught owing to increased cohort sizes. Between cohorts there was a handover between foundation doctors leading the sessions. Foundation doctors were selected by Dr Bains to lead the session where it was felt they had demonstrated interest in teaching.Students received a detailed explanation of the purpose and methods of completing a NIPE, followed by an opportunity to watch and then practice the skills under observation in small groups.Students were given a pre and post questionnaire which explored their confidence performing a NIPE and assessed their knowledge. In the first phase this was a 9-question quiz and then progressed to a 10-question quiz to ensure we incorporated all 4 key elements of the screening (hips, heart, eyes and testes).What did you find?Overall, we received 98 responses to the pre-session questionnaire and 71 responses to the post-study questionnaire, which were analysed after each session to improve the next. Unfortunately, the pre-session questionnaire results for one cohort were lost. These values were entirely excluded from the final data set.The average pre-session score was 34% with the average post session score being 80%, an average improvement of 46%.Across both cohorts, the majority of students became more confident with performing the examination. Students gave an average self-rating of 1.8 pre -session compared to 4.2 post session (1 being not at all confident and 5 being very confident).A similar pattern was seen with personal perception of knowledge of the exam and what it involves, with an average self-rating score of 1.35 pre-session compared to 4.25 post session (1 being ‘I know nothing’ and 5 being ‘I know everything’)Feedback comments included:‘Very well taught and clinically relevant’‘Really good and concise with good practical skills at the end’This also resulted in feedback for the FDs involved who could add this teaching to their portfolio as supervised learning events/examples of delivering teaching.What does it mean?This project demonstrates a mutual benefit; giving FDs the opportunity to teach whilst also demonstrating a consistent improvement in students’ knowledge and confidence around the NIPE. Moving forward we are planning to expand this project to focus on supporting more foundation trainees in the region to build their teaching skills.

President Trump's military parade set to roll throughWashington, D.C. as seven million pounds of military hardware will hitthe streets this evening. Iran launched a new wave of missiles towardIsrael this morning and that continued a night of attacks between thetwo sides that caused destruction in both Tel Aviv and Tehran. SeanCombs' federal trial for sex trafficking and racketeering is nearingits conclusion, with prosecutors considering dismissing a juror asKanye West publicly showed support by visiting the courthouse. TheOklahoma City Thunder rallied in the fourth quarter to defeat theIndiana Pacers 111-104 in Game 4 of the NBA Finals, tying the seriesat 2-2 and regaining home-court advantage. GUESTS: Kori Schake, Aaron David Miller

Ukraine officials said that 60 people are feared dead followinga bombing on a school in the eastern Luhansk region. President Bidenis holding a virtual summit today with other G7 leaders and UkrainianPresident Volodymyr Zelenskyy. Senate Democrats are promising a voteon codifying abortion rights into law after the leak of that SupremeCourt draft opinion overturning Roe versus Wade. GUESTS: Jane Oates, Randi Weingarten

Knowledge products comprise assessments of authoritative information supported by standards, governance, quality control, data, tools, and capacity building mechanisms. Considerable resources are dedicated to developing and maintaining knowledge products for biodiversity conservation, and they are widely used to inform policy and advise decision makers and practitioners. However, the financial cost of delivering this information is largely undocumented. We evaluated the costs and funding sources for developing and maintaining four global biodiversity and conservation knowledge products: The IUCN Red List of Threatened Species, the IUCN Red List of Ecosystems, Protected Planet, and the World Database of Key Biodiversity Areas. These are secondary data sets, built on primary data collected by extensive networks of expert contributors worldwide. We estimate that US$160 million (range: US$116-204 million), plus 293 person-years of volunteer time (range: 278-308 person-years) valued at US$ 14 million (range US$12-16 million), were invested in these four knowledge products between 1979 and 2013. More than half of this financing was provided through philanthropy, and nearly three-quarters was spent on personnel costs. The estimated annual cost of maintaining data and platforms for three of these knowledge products (excluding the IUCN Red List of Ecosystems for which annual costs were not possible to estimate for 2013) is US$6.5 million in total (range: US$6.2-6.7 million). We estimated that an additional US$114 million will be needed to reach pre-defined baselines of data coverage for all the four knowledge products, and that once achieved, annual maintenance costs will be approximately US$12 million. These costs are much lower than those to maintain many other, similarly important, global knowledge products. Ensuring that biodiversity and conservation knowledge products are sufficiently up to date, comprehensive and accurate is fundamental to inform decision-making for biodiversity conservation and sustainable development. Thus, the development and implementation of plans for sustainable long-term financing for them is critical.