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We detail an extensive characterisation study on a previously described dual amperometric H2O2 biosensor consisting of H2O2 detection (blank) and degradation (catalase) electrodes. In vitro investigations demonstrated excellent H2O2 sensitivity and selectivity against the interferent, ascorbic acid. Ex vivo studies were performed to mimic physiological conditions prior to in vivo deployment. Exposure to brain tissue homogenate identified reliable sensitivity and selectivity recordings up to seven days for both blank and catalase electrodes. Furthermore, there was no compromise in pre- and post-implanted catalase electrode sensitivity in ex vivo mouse brain. In vivo investigations performed in anaesthetised mice confirmed the ability of the H2O2 biosensor to detect increases in amperometric current following locally perfused/infused H2O2 and antioxidant inhibitors mercaptosuccinic acid and sodium azide. Subsequent recordings in freely moving mice identified negligible effects of control saline and sodium ascorbate interference injections on amperometric H2O2 current. Furthermore, the stability of the amperometric current was confirmed over a five-day period and analysis of 24-h signal recordings identified the absence of diurnal variations in amperometric current. Collectively, these findings confirm the biosensor current responds in vivo to increasing exogenous and endogenous H2O2 and tentatively supports measurement of H2O2 dynamics in freely moving NOD SCID mice.

We describe the in vivo characterization of microamperometric sensors for the real-time monitoring of nitric oxide (NO) and oxygen (O2) in the striatum of immunocompromised NOD SCID mice. The latter strain has been utilized routinely in the establishment of humanized models of disease e.g., Parkinson’s disease. NOD SCID mice were implanted with highly sensitive and selective NO and O2 sensors that have been previously characterized both in vitro and in freely moving rats. Animals were systemically administered compounds that perturbed the amperometric current and confirmed sensor performance. Furthermore, the stability of the amperometric current was investigated and 24 h recordings examined. Saline injections caused transient changes in both currents that were not significant from baseline. l-NAME caused significant decreases in NO (p < 0.05) and O2 (p < 0.001) currents compared to saline. l-Arginine produced a significant increase (p < 0.001) in NO current, and chloral hydrate and Diamox (acetazolamide) caused significant increases in O2 signal (p < 0.01) compared against saline. The stability of both currents were confirmed over an eight-day period and analysis of 24-h recordings identified diurnal variations in both signals. These findings confirm the efficacy of the amperometric sensors to perform continuous and reliable recordings in immunocompromised mice.

Introduction An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non‐specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. Methods ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. Results There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. Discussion In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback‐driven curriculum design. Cancer care is multi‐disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. Conclusion The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non‐specialists on topics in cancer prevention, screening, and survivorship care. In this second year, this ECHO reached 213 unique participants in 247 zip codes, 30 Indiana counties, 32 states, and 4 countries. This ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback‐driven curriculum design created to be more accessible.

Integrated care demands a workforce that is confident, capable and compassionate. This is dependent on a willingness to work inter-professionally and understand the roles, standards and values of other professional groups. However, there are few examples of integrated care initiatives within higher education that aim to build the knowledge and skills required to support effective integrated, people-centred care. While satisfying, working in the helping professions is emotionally challenging and for students' these challenges are often underestimated. Some students struggle through their studies with many failing to complete and others drop out in the early years of their careers. Understanding what supports students to thrive in their professional roles is essential to retention of a highly skilled integrated workforce. To address this challenge, this paper outlines a conceptual framework designed to promote a pedagogical environment focused on creating the conditions for integrated working. The framework is based on the \"student lifecycle\", from starting to see the benefits of a career in the helping professions, developing a sense of belonging through to thriving and succeeding as future practitioners. It outlines how students are supported to develop emotional resilience, inter-professional empathy and reflexivity to help them stay and stay well in their careers.

The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression. We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms. We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs). Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (-6.366 to -0.029). The proportion of the maximum possible indirect effect estimated was κ(2 )=.54 (95% CI .426-.640). This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor. ClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k).

An estimated 15-22% of Canadian kindergarten-age children have a special health need (SHN), defined as a clinical diagnosis, a functional need requiring special accommodation at school, or a health condition leading to increased needs. Children with SHN may be more likely to experience mental health disorders than their peers without SHN, placing them at risk for further health and academic challenges. Our objective was to determine the odds of children with SHN identified in kindergarten being diagnosed with a mental health disorder by age 16. In this retrospective cohort study using population-based, linked administrative data, we identified children with SHN born 1995-2020 in Manitoba, Canada, and enrolled in kindergarten from 2006-2011. The SHN designation is derived from the Early Development Instrument. We measured prevalence of common childhood mental health disorders (ADHD, mood/anxiety disorders, conduct disorders) in children with SHN to age 16. Using binary logistic regressions, we calculated crude odds ratios (OR) for children with vs. without SHN being diagnosed with a mental health disorder, then adjusted for age, sex, and neighbourhood-level income. Among 42,766 children, 13.8% had a SHN designation in kindergarten. Among these, 41.0% were diagnosed with a mental health disorder by age 16. The odds of a mental health diagnosis by SHN category were: special needs designation in kindergarten (OR 1.75, 95%CI 1.53-2.01); learning impairment (OR 1.61, 95%CI 1.39-1.86); behavioural impairment (OR 3.27, 95%CI 2.87-3.72); and emotional impairment (OR 2.01, 95%CI 1.75-2.32). Children with SHN (vs. none) had higher odds of a mental health disorder if they had 1 + impairment (OR 1.67, 95%CI 1.50-1.85). Adjusting for sociodemographic characteristics did not change the estimates. The study highlights important kindergarten predictors of future mental health disorders in children, which should be used to inform preventive and supportive strategies for children with SHN and help generate wider mental health supports in schools.

Background: Supporting students undertaking professional courses in health and social care prepare for the realities of integrated care is essential to retention of a highly skilled integrated workforce. Globally, it is estimated that there will be a shortfall of 10 million healthcare workers worldwide by 2030 (1). At the same time, ethnic diversity and an ageing population will require inclusive person-centred care. What is the issue: While satisfying, working in the helping professions is emotionally challenging and for students’ these challenges are often under-estimated. Some students struggle through their studies with many failing to complete and others drop out in the early years of their careers, with stress and lack of support cited as the key drivers for exit. This leads to an endless cycle of recruitment to meet demands for the ever-growing need for integrated care. What is the intervention: To address this issue, the University Bedfordshire, England has introduced a framework that aims to prepare health and social care students for delivering integrated care. It draws on curriculum principles identified via Barraclough et al.’s scoping review of education, training and workforce development in integrated care to create the conditions for integrated working (2). The approach is based on the “student lifecycle”, capturing student experience from preparing for university to final qualification and beyond into professional life. It is organised around the themes of begin, belong, thrive and succeed. At each stage, incremental support is provided via initiatives that aim to promote self-confidence, emotional resilience and inter-professional reflexivity. The framework is designed to enable students to successfully: •Begin: by fostering self-belief, self-confidence and curiosity pre-entry via a culturally competent outreach programme that engages diverse communities and prospective students about the benefits of a career in integrated care •Belong: at university by co-creating a new initiative with health and social care students to improve their sense of belonging to their professional courses •Thrive: through developing a thirst for inter-professional learning and self-improvement by participating in Schwartz Rounds and integrated care simulations co-developed by staff and students •Succeed: by enhancing emotional resilience via a new web application to help students and qualified staff improve their personal resilience and introducing a module on inter-professional reflective supervision along with reflective practice groups to support inter-professional reflexivity and anti-racist practice.   Target audience: Universities involved in teaching and learning new and existing health and social care professionals. Learning/takeaways: Providing holistic, person-centred care can be both rewarding and emotionally challenging and, given international challenges in recruitment and retention the framework may resonate beyond England. Next steps: While evaluation is in its early stages, it is hoped that the approach will increase diversity, reduce attrition during training and promote greater inter-professional empathy, communication and collaboration for effective inter-professional practice to enable students stay and stay well in integrated care. References 1.World Economic Forum. Global health and healthcare strategic outlook: shaping the future. Geneva; 2023 2.Barraclough F, et al. Workforce development in integrated care: a scoping review. Int J Integr Care. 2021;21(4).  

Background Dental problems are the most prevalent chronic disease worldwide, with up to half of all kindergarten children having tooth decay. However, there is a lack of evidence of whether unaddressed dental needs (UDNs) are associated with children’s developmental health, a concept reflecting holistic child development - encompassing physical, emotional, and cognitive development. The objective of the current study was to evaluate the relationship between UDNs and developmental health among kindergarten children using the Early Development Instrument (EDI). Methods We examined associations between teacher reported UDNs and developmental vulnerability on the EDI. Children were included in the study if they were enrolled in kindergarten in publicly-funded schools in Canada between 2010 and 2015, had been in the classroom for at least one month, and had no more than 25% of missing items on the questionnaire. Results Among 576,264 children who met inclusion criteria (95.4% of eligible children), 2465 (0.4%) were identified as having UDNs by their teachers. Children with UDNs had 4.58 to 8.27 times higher odds of being vulnerable on any of the five developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge), compared to children without UDNs. Conclusion In this study, teacher-reported UDNs were associated with developmental vulnerability in kindergarten children. Teacher reported unmet dental needs in kindergarten children may be a proxy for poor developmental health at school entry, and thus a marker for supporting both children’s oral health and early developmental needs.

Background Investing in children’s early years can have a lasting positive effect, such as better academic outcomes throughout their school careers. In Jordan, investments have been made in early childhood development and early childhood care and education to improve children’s school readiness. School readiness comprises a range of abilities needed to succeed in school, including physical, emotional, social, and cognitive skills. To measure the impact of these investments on children’s school readiness, Jordan has been implementing the Early Development Instrument (EDI), a population-level, teacher-completed checklist of children’s school readiness, assessing children’s development in five main areas, referred to as domains. Methods The goal of the current study was to examine the psychometric properties of the Arabic version of the EDI, using data collected in 2018 on a sample of 5965 children in Jordan. The EDI was translated from the original English version to Arabic and adapted for use in Jordan. We conducted a categorical confirmatory factor analysis (CFA) for each of the five domains of the EDI and examined the reliability of the domains and subdomains using Cronbach’s alpha reliability coefficient. Results With few exceptions, the study results are in line with those of the analysis of the psychometric properties found with the original, Canadian English version of the EDI in a population of Canadian children. Results of CFAs demonstrated, for the most part, good model fits. Internal consistency indices of the domains ranged from 0.74 for physical health and well-being to 0.96 for social competence. For the subdomains, they ranged from 0.42 to 0.94. Conclusions Our results provide empirical support for the adaptation of the EDI for population monitoring of school readiness in Jordan. Validation of the Arabic adaptation opens up the possibility of assessing school readiness of young children in Jordan in comparison to the many other countries that have successfully adapted and applied the EDI.