Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance-Altering Conditions, Injury, or Treatment Effects: An Updated Systematic Review.

OBJECTIVE: Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties have previously been reviewed by Jenkinson et al. This review aimed to identify and critically assess recent studies evaluating the effectiveness of psychosocial interventions for children and young people with visible differences on psychosocial wellbeing, self-esteem, and social experiences and compare the findings with Jenkinson et al. using a replacement review process. METHODS: Inclusion criteria are as follows: studies with participants aged 0-18 years with visible differences; investigating a psychosocial intervention; including comparison with an alternative intervention, control group, or pre- and post-intervention; and including a quantitative measure assessed pre- and post-intervention. Exclusion criteria are as follows: participants with body dysmorphic disorder or appearance changes due to eating disorders or obesity and studies not written in English. MEDLINE, AMED, and PsycInfo were searched and grey literature was included. Results were reviewed against eligibility criteria, data were extracted, and studies were evaluated using the Cochrane Risk of Bias 2 tool. RESULTS: Using Jenkinson et al. as one source of studies, 24 studies were included evaluating a range of interventions such as social interaction skills training, residential social camps, and cognitive behavioral therapy. Risk of bias was high in 20 studies and of some concern in four studies. CONCLUSION: There is some evidence of the effectiveness of hypnotherapy, a relaxation response resiliency program, integrative body-mind-spirit group, and therapeutic patient education, but more rigorous research is needed to confirm their impact on psychosocial outcomes.

How safe and effective are paediatric virtual fracture clinics? A systematic review.

Introduction: Virtual fracture clinics (VFC) involve a consultant-led multidisciplinary team meeting where cases are reviewed before a telephone consultation with the patient. VFCs have the advantages of reducing waiting times, outpatient appointments and time off school compared to face-to-face (F2F) fracture clinics. There has been a surge in VFC use since the COVID-19 pandemic but there are still concerns over safety in the paediatric population. Fractures make up a large burden of paediatric injuries, therefore research is required on the safety and efficacy of paediatric VFCs. This systematic review will look at the safety and effectiveness of paediatric VFCs, as well as determine the cost-effectiveness and parent preferences. Methods: As per the PRISMA guidelines two independent reviewers searched the following databases: Medline, Embase and Web of Science. Studies were included if children under 18 years old presented to A&E with a suspected or confirmed simple un-displaced fracture and were referred to a VFC. The primary outcomes assessed were effectiveness and safety, with the secondary outcomes of cost-effectiveness and parent satisfaction. Results: Six studies met the inclusion criteria for this systematic review. There was a high rate of direct discharge from the VFC leading to reduced outpatient appointments. All patients were seen within 72 h of presentation. There were limited incidences of missed fractures and the rates of re-presentation were similar to that of F2F orthopaedic clinics. There were significant cost savings for the hospitals and high parent satisfaction. Discussion: VFCs have shown to be safe and effective at managing most stable, low operative risk paediatric fractures. Safety must be ensured with a telephone helpline and an open return to fracture clinic policy. More research is needed into specific paediatric fracture types to be managed in the VFC. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier: CRD42023423795.

Multimodal Neuroimaging Summary Scores as Neurobiological Markers of Psychosis.

BACKGROUND AND HYPOTHESIS: Structural brain alterations are well-established features of schizophrenia but they do not effectively predict disease/disease risk. Similar to polygenic risk scores in genetics, we integrated multifactorial aspects of brain structure into a summary "Neuroscore" and examined its potential as a marker of disease. STUDY DESIGN: We extracted measures from T1-weighted scans and diffusion tensor imaging (DTI) models from three studies with schizophrenia and healthy individuals. We calculated individual-level summary scores (Neuroscores) for T1-weighted and DTI measures and a combined score (Multimodal Neuroscore-MM). We assessed each score's ability to differentiate schizophrenia cases from controls and its relationship to clinical symptomatology, intelligence quotient (IQ), and medication dosage. We assessed Neuroscore specificity by performing all analyses in a more inclusive psychosis sample and by using scores generated from MDD effect sizes. STUDY RESULTS: All Neuroscores significantly differentiated schizophrenia cases from controls (T1 d = 0.56, DTI d = 0.29, MM d = 0.64) to a greater degree than individual brain regions. Higher Neuroscores (ie, increased liability) were associated with lower IQ (T1 ß = -0.26, DTI ß = -0.15, MM ß = -0.30). Higher T1-weighted Neuroscores were associated with higher positive and negative symptom severity (Positive ß = 0.21, Negative ß = 0.16); Higher Multimodal Neuroscores were associated with higher positive symptom severity (ß = 0.30). SZ Neuroscores outperformed MDD Neuroscores in predicting IQ (T1: z = 3.5, q = 0.0007; MM: z = 1.8, q = 0.05). CONCLUSIONS: Neuroscores are a step toward leveraging widespread structural brain alterations in psychosis to identify robust neurobiological markers of disease. Future studies will assess ways to improve neuroscore calculation, including developing the optimal methods to calculate neuroscores and considering disorder overlap.

Re-suspension of T(1)44 vaccine cultures of Mycoplasma mycoides subsp mycoides SC in 1 molar MgSO(4) causes a drop in pH and a rapid reduction in titre.

The effect of reconstituting freeze-dried vaccine cultures of Mycoplasma mycoides subsp. mycoides small colony biotype (MmmSC) strain T(1)44 grown in standard vaccine medium using variable quantities of un-buffered solutions of 1 M MgSO(4) (the current O.I.E.-recommended procedure) has been investigated. Compared to the culture pH prior to desiccation, a drop of up to 2.2 pH units was observed, dependent upon the volume and pH of 1 M MgSO(4) used (1-30 x original culture volume, using 1 M MgSO(4) in the pH range 5.4-7.6). This pH drop appears to be due to the removal of the HPO(4)(2-) buffer capacity of the medium by the formation of insoluble Mg(3)(PO(4))(2) and the release of free H(+) ions. As a result of this lower pH, markedly reduced culture viability was observed over an 8-h period at 37 degrees C for vaccines re-suspended in 1 M MgSO(4) (ca. 6 log(10) drop in titre) compared to re-suspension in dH(2)O (ca. 1.5 log(10) drop in titre). Re-suspension in 1 M MgSO(4) did exhibit a thermoprotective effect at 46 degrees C, but only when the pH was maintained above pH 7.0 by use of HEPES-buffered growth medium (1 log(10) drop in titre compared to 6 log(10) drop using dH(2)O over an 8-h period). Since all current O.I.E.-recommended growth media for MmmSC are based upon a phosphate buffer system, it is therefore recommended that the use of 1 M MgSO(4) as a reconstitution fluid be discontinued as soon as possible and buffered saline be used instead. The use of this reconstitution procedure with the T(1)44 vaccine strain could be a significant factor in the poor efficacy observed with current freeze-dried vaccines against contagious bovine pleuropneumonia in Africa.

Ligation of arabinogalactan to peptidoglycan in the cell wall of Mycobacterium smegmatis requires concomitant synthesis of the two wall polymers.

To study the late events of cell wall assembly in Mycobacterium smegmatis, specific in vivo radiolabelling of exponentially growing liquid cultures over periods of less than one cell generation were carried out. N-Acetyl-[(14)C]glucosamine was used to label peptidoglycan and [(14)C]glucose to label arabinogalactan and arabinomannan. Over periods of several generations, radioactive cell wall material was turned over as soluble autolysis products into the culture fluid. However, turnover of newly synthesized and labelled cell wall was delayed for about one cell generation, implying inside-to-outside growth of the wall as observed in Bacillus. Little radioactive wall material was released into the culture fluid during the first generation of labelling in growing cultures, but the addition of amoxicillin plus the beta-lactamase inhibitor clavulanic acid, at the minimum inhibitory concentration of amoxicillin, led to the release of radioactive peptidoglycan that could be isolated by gel filtration chromatography and contained nearly 3 mol alanine per glutamic acid residue, indicating that it was linear, un-crosslinked peptidoglycan that had never been substantially cross-linked to the cell wall due to inhibition of transpeptidation by amoxicillin. This peptidoglycan had no covalently attached arabinogalactan. Radioactive arabinogalactan was synthesized and released from the amoxicillin-treated bacteria without attachment to peptidoglycan. The results indicate that during growth, incorporation of arabinogalactan into the cell wall requires its ligation to newly synthesized peptidoglycan and that the peptidoglycan must be undergoing concomitant cross-linking to the inner surface of the cell wall. Inhibition of peptidoglycan transpeptidation prevents ligation of arabinogalactan to peptidoglycan and its consequent incorporation into the wall.