The Lunar Environment Heliophysics X-ray Imager (LEXI) Mission

The Lunar Environment heliospheric X-ray Imager (LEXI) is a wide field-of-view soft X-ray telescope developed to study solar wind-magnetosphere coupling. LEXI is part of the Blue Ghost 1 mission comprised of 10 payloads to be deployed on the lunar surface. LEXI monitors the dayside magnetopause position and shape as a function of time by observing soft X-rays (0.1-2 keV) emitted from solar wind charge-exchange between exospheric neutrals and high charge-state solar wind plasma in the dayside magnetosheath. Measurements of the shape and position of the magnetopause are used to test temporal models of meso- and macro-scale magnetic reconnection. To image the boundary, LEXI employs lobster-eye optics to focus X-rays to a microchannel plate detector with a 9.1× ∘ 9.1 ∘ field of view.

An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol

BACKGROUND

Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting.

METHODS

In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained.

DISCUSSION

Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.

The COV-ED Survey: exploring the impact of learning and teaching from home on parent/carers' and teachers' mental health and wellbeing during COVID-19 lockdown

BACKGROUND

Following the emergence of COVID-19 in the UK, on March 18^th 2020 the majority of schools in England closed and families and teachers were tasked with providing educational support for children and adolescents within the home environment. Little is known, however, regarding the impact of remote teaching and learning on the mental wellbeing of parents/carers and teaching staff.

METHODS

The Coronavirus Education (COV-ED) online survey explored the practicalities of learning and teaching from home for 329 parents/carers and 117 teachers of 11-15 year old adolescents in England, during June/July 2020, and the associated impact on their mental wellbeing. Participants were recruited through schools and via University of Warwick social media channels. Data was analysed using a series of Multiple Linear and Multivariate Regressions.

RESULTS

Despite coping well with the challenges of remote learning, a third of teachers reported below average mental wellbeing on the Warwick-Edinburgh Mental Wellbeing Scale. Multivariate regression revealed that wellbeing was associated with access to resources and confidence to teach from home. Almost half of parents/carers surveyed reported below average wellbeing. Multivariate regression revealed that poor wellbeing was more common in those who were also working from home and who lacked support for their own mental health. Concerns about their child's mental health and lack of access to electronic devices and workspace were also significantly associated with the mental wellbeing of parents/carers.

CONCLUSIONS

Whilst young people's mental health and wellbeing has, and continues to be a national priority, the mental health and wellbeing of the families and teachers supporting them has not previously been explored. Our survey population was of predominantly white British heritage, female and living in the West Midlands UK, therefore, findings should be treated with caution. Findings provide a snapshot of factors that may be of significance to families and schools in supporting the mental wellbeing of those tasked with learning from home. They will help i) increase knowledge and awareness with regard to future support of families and teachers during similar crises; ii) enable the design and development of practical solutions in the delivery of remote teaching and learning; and, iii) help address the mental wellbeing needs of those tasked with supporting adolescents.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

The impact of emotional acknowledgement and self-esteem on resilience to family dysfunction

Introduction

Family dysfunction can test the resilience of adolescents, specifically those from single parent families and those attending schools in more socio-economically challenged areas.

Objectives

To determine what factors are associated with resilience for those from single parent families or attend schools in more socio-economically challenged areas.

Aims

To examine the role of emotional regulation and self-esteem as putative resilience factors in the context of single parents status and socioeconomic disadvantage.

Methods

Secondary school pupils from single and dual parent families aged 13 to 15 answered questionnaires at three time points on: emotional regulation, self-esteem, depression and anxiety. A total of 434 pupils took part at time 1, 574 at time 2, and 467 at time 3. The secondary schools were categorised into more and less disadvantaged schools.

Results

Positive self-esteem [F(1.205) = 54.568, P = 0.000; F(1.157) = 35.582, P = 0.000] and emotional regulation [F(1.205) = 46.925, P = 0.000; F(1.157) = 16.583, P = 0.000] were both associated with resilience against depression in adolescents from single parent families. Positive self-esteem [F(1,75) = 102.629, P = 0.000; F(1.355) = 60.555, P = 0.000] and emotional regulation [F(1.60) = 34.813, P = 0.000; F(1.73) = 36.891, P = 0.000] were both associated with resilience against depression in adolescents attending more socio-economically challenged areas.

Conclusions

This research suggests that adolescent resilience against depression may be promoted by improving self-esteem and emotional regulation. Therefore, future interventions could focus on boosting these resilience factors. Further resilience research could include emotional regulation and self-esteem as protective factors for resilience in adolescent mental health. As these variables have been identified, they can help find more pieces to the complex puzzle of resilience.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies

Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).

Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy

Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.

Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics

Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.

Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

The attitude of healthcare professionals plays an important role in the uptake of diabetes self-management education: analysis of the Barriers to Uptake of Type 1 Diabetes Education (BUD1E) study survey

AIM

To explore reasons for the poor uptake of accredited diabetes self-management education (DSME) in adults with Type 1 diabetes.

METHODS

The study was set in an urban population in South London, UK. A cross sectional survey gathered demographic, diabetes service-use data, psychological scores and reasons for non-attendance at locally-available DSME. In addition, 56 healthcare professionals were surveyed.

RESULTS

Responses to surveys were returned by 496 adults with Type 1 diabetes (33% response rate), of whom 263 had attended DSME (53%). Multivariable analysis adjusted for significant variables identified four key variables influencing attendance. Non-attendance was associated with men (OR 0.55 CI 0.37-0.84, p = 0.005), lower educational attainment (OR 0.45 CI 0.28-0.73, p = 0.001), higher glycated haemoglobin (OR 1.74 CI 1.03-2.94, p = 0.04) and healthcare professional encouragement to attend (OR 1.7 CI 1.28-2.3, p = 0.001). The most frequently reported barriers to attendance were work (37%) and time (14%) commitments. Only 49% of healthcare professionals (HCPs) correctly identified the most likely barriers. Those HCPs who had observed courses believed more in their efficacy, with higher uptake within their clinic population.

CONCLUSIONS

Social determinants of health, particularly educational attainment and gender, increase health inequalities by influencing decisions to attend evidence-based education courses. Healthcare professional communication is paramount to encourage attendance, and observation of a course may facilitate this.

The impact of the transition from primary school to secondary school on young adolescents

Introduction

Previous research suggests that adult anxiety disorders begin in adolescence and the transition from primary school to secondary school is the first challenge many young adolescents face, which could test their resilience for the first time.

Objectives

To examine students’ anxiety scores before and after their transition, and what protective and risk factors are present during this challenge.

Aims

To determine how the transition can impact anxiety in children, and if protective factors can help decrease the disruption that the transition can cause.

Methods

One hundred and eighty-four pupils completed questionnaires in their last term of primary school and during the first term of secondary school. At time 1: the attachment, school membership, and bullying and victimization measures were compared with pupils’ anxiety scores, along with whether their friends or siblings will be attending the same secondary school as them. These analyses will also be conducted once the pupils start secondary school, at time 2.

Results

Secure attachment was associated with lower anxiety and transition anxiety (F(2.56) = 7.255, P = .002; F(2.52) = 19.245, P = .000; F(2.181) = 10.181, P = .000; F(2.53) = 20.545, P = .000). School membership was associated with lower transition anxiety (F(2.181) = 4.151, P = .017; F(2.181) = 3.632, P = .028). Low victimisation was also associated with low anxiety and transition anxiety (F(2.181) = 14.024, P = .000; F(2.181) = 14.529, P = .000; F(2.181) = 9.381, P = .000).

Conclusions

These preliminary results suggest that attachment, school membership and victimisation all impact on pupils anxiety before they transition to secondary school. Therefore, schools could work together to increase school membership and decrease victimisation, particularly for pupils who they suspect will struggle with the transition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Collision tumour of the breast composed of Merkel cell carcinoma and invasive ductal carcinoma: a case report

We report a case of a 71-year-old female with a palpable breast mass. Pathologic evaluation of the breast mass showed a unique collision tumour with a high-grade invasive and in-situ ductal carcinoma component and a high-grade neuroendocrine carcinoma component. The neuroendocrine component turned out to be Merkel cell carcinoma (MCC), with immunohistochemical confirmation. To the best of our knowledge, this is the first case report of a collision tumour with ordinary ductal carcinoma and MCC in the breast.

Comparison of immunohistochemistry by automated cellular imaging system (ACIS) versus fluorescence in-situ hybridization in the evaluation of HER-2/neu expression in primary breast carcinoma

AIMS

Immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) are both commonly used assays for evaluation of HER-2/neu status in breast cancer. However, there is still no consensus on which method is most predictive of patient response to Herceptin. Recently, the automated cellular imaging system (ACIS) has been shown to improve the accuracy and reproducibility in scoring IHC. Our aim was to compare the results of HER-2/neu expression and gene amplification in the same patients by IHC using the ACIS system and by FISH.

METHODS AND RESULTS

Two hundred and forty-seven breast cancer cases were studied. The concordance rate between IHC-ACIS (> or = 2.2) and FISH (> or = 2.0) was 94%. Fifteen patients were discordant; three had borderline FISH values and three had borderline IHC values. The other nine discordant cases consisted of five IHC-ACIS+, FISH- and six IHC-ACIS-, FISH+. HER-2/neu overexpression was more common in tumours that were high-grade, aneuploid, progesterone receptor and bcl-2 negative, with MIB-1 > 10%.

CONCLUSION

HER-2/neu assessment by the ACIS is reliable, rapid and inexpensive, and correlates highly with results obtained by FISH.

Outpatient management of DVT using low molecular weight heparin and a hospital outreach service

In recent years there have been several studies comparing the efficacy and safety of low molecular weight (LMW) and unfractionated heparin for the treatment of deep venous thrombosis (DVT), showing them in the clinical trial setting to be equal in these regards. LMWH has the advantage of once daily subcutaneous injection and daily monitoring of levels is not usually required. This has led many centres to develop outpatient treatment strategies for these patients but evidence for the safety of this approach is scarce. In 1997 we developed a hospital outreach service for the treatment of patients with DVT and, in a retrospective study, have compared the outcome in 172 patients treated at home with 172 age, sex and thrombotic risk factor matched inpatients treated at our institution with unfractionated heparin. Five patients in the home treatment group suffered a haemorrhagic event, compared with six patients in the hospital group. One patient in the home treatment group had a recurrent DVT within the first 3 months of treatment; in the hospital-treated group, six patients had recurrent DVTs and nine developed pulmonary emboli. At 3 months, there were three deaths in the home treatment group, compared with five deaths in the hospital group. There was no difference in re-admission rate at 3 months: 23 in the home treatment group, 24 in the hospital-treated group. Average length of hospital stay for the home-treatment group was 2.1 days and 12 days for the hospital group. Warfarin control was found to be significantly better in those patients treated at home, and only 18% of patients treated in hospital received heparin according to hospital guidelines. In conclusion, outpatient management of patients with DVT using LMWH is as safe as hospitalization and continuous infusion of unfractionated heparin. The complication rate was lower in the home treatment group and, in particular, the incidence of recurrent thrombosis was significantly less in the home treatment group. In addition, warfarin control was better when managed by specialist nurses. Patients expressed a preference for home treatment.

Genetic testing for Alzheimer's disease

Genetic factors are important in the development of Alzheimer's disease (AD). Familial AD can result from rare mutations in some genes. Other genes, such as the apolipoprotein E gene (APOE), operate as risk factors for late-onset sporadic AD. On a background of advances in the genetics of AD we suggest a way in which genetic information may be used in the diagnosis of AD. If there is a positive family history of early-onset dementia and the clinical features suggest AD, patients may be tested for presenilin and amyloid precursor protein gene mutations with appropriate pretest and post-test counselling. Predictive testing should be performed under guidelines developed by the World Federation of Neurology and the Human Genetics Society of Australasia. The usefulness of APOE genotyping as an adjunct to conventional diagnostic tests is unknown; data suggest it has low sensitivity and specificity and may have little predictive value in an individual patient. APOE genotyping should not be performed in asymptomatic individuals, except as part of an ethically approved research project; this recommendation is supported by a number of international consensus statements. APOE testing should not be used as a diagnostic test without adequate pretest and post-test counselling, education and support. APOE testing should not be used as a sole diagnostic test in the work-up of patients with AD. Genetic risk factors other than APOE require validation and should not be used routinely, except as part of an ethically approved research protocol.

Ways forward for shared learning between nursing and social work students

This paper is based on the work of Connor (1995) which examined the potential for shared learning on qualifying programmes of social work and nurse education in Wales. The research was carried out mainly by interviewing 44 providers of social work and nurse education in the 13 colleges delivering qualifying courses throughout Wales. The main findings indicate that: nursing and social work educators have a positive attitude to shared learning, provided that the focus is on sharing appropriate areas of learning and not on joint training; there are considerable areas of commonality between social work and nurse education that could be shared; obstacles to shared learning mainly concern structural and resource issues which would require the appropriate political will to implement shared learning programmes; and there are a wide variety of models that could be used to implement future shared learning. The management of this project with its commitment to collaboration between the two professional groups throughout the process of enquiry is offered as a model for further research projects.

Evaluation of a recombinant yeast cell estrogen screening assay

A wide range of chemicals with diverse structures derived from plant and environmental origins are reported to have hormonal activity. The potential for appreciable exposure of humans to such substances prompts the need to develop sensitive screening methods to quantitate and evaluate the risk to the public. Yeast cells transformed with plasmids encoding the human estrogen receptor and an estrogen responsive promoter linked to a reporter gene were evaluated for screening compounds for estrogenic activity. Relative sensitivity to estrogens was evaluated by reference to 17 beta-estradiol (E2) calibration curves derived using the recombinant yeast cells, MCF-7 human breast cancer cells, and a prepubertal mouse uterotrophic bioassay. The recombinant yeast cell bioassay (RCBA) was approximately two and five orders of magnitude more sensitive to E2 than MCF-7 cells and the uterotrophic assay, respectively. The estrogenic potency of 53 chemicals, including steroid hormones, synthetic estrogens, environmental pollutants, and phytoestrogens, was measured using the RCBA. Potency values produced with the RCBA relative to E2 (100) included estrone (9.6), diethylstilbestrol (74.3), tamoxifen (0.0047), alpha-zearalanol (1.3), equol (0.085), 4-nonylphenol (0.005), and butylbenzyl phathalate (0.0004), which were similar to literature values but generally higher than those produced by the uterotrophic assay. Exquisite sensitivity, absence of test compound biotransformation, ease of use, and the possibility of measuring antiestrogenic activity are important attributes that argue for the suitability of the RCBA in screening for potential xenoestrogens to evaluate risk to humans, wildlife, and the environment.

Congenital mucoceles: report of two cases

Congenital mucoceles are very rare. Only two previous cases presenting in the neonatal period have been reported. Two cases are presented here, one arising within the tongue and the other in the floor of the mouth. In both cases the mucoceles became apparent soon after birth because they interfered with mouth closure and normal feeding. The cysts were surgically excised and histopathological examination showed that they were retention cysts. The infants quickly resumed normal oral function and swallowing after surgical removal.

Parathyroid hormone-like peptide and parathyroid hormone are secreted from bovine parathyroid via different pathways

Parathyroid hormone-like peptide is a recently discovered protein which is thought to be responsible for the hypercalcemia of malignancy. Through the use of radioimmunoassay, Northern analysis and Western blot techniques this protein has been demonstrated to occur in a variety of tumor and normal cells. Its role in normal physiology is not established nor is there knowledge regarding its synthesis, secretion, and storage. We have investigated characteristics of the secretion of parathyroid hormone-like peptide in bovine parathyroid gland slices and cells to learn whether or not this protein is secreted in a manner similar to that of parathyroid hormone. We have used radioimmunoassays specific for PTH and PTH-rP to measure the secretion of each protein and have found that, unlike PTH, PTH-rP secretion was not influenced by the medium calcium concentration. Similarly, PTH-rP secretion was not influenced by other known PTH secretagogues such as c-AMP or isoproterenol. An examination of the subcellular distribution of PTH-rP revealed that 75-90% of it occurs in the soluble fraction of cell lysates. Analysis of isolated secretory granules demonstrated the presence of PTH while PTH-rP was undetectable in these organelles. We conclude that PTH-rP is not secreted from parathyroid cells via the regulated pathway utilizing PTH secretory granules.

Cross-contamination control in prosthodontic practice

Prosthodontic patients are generally a high-risk group relative to their potential to transmit infectious diseases as well as acquire them. There has been a recent increase in awareness of the need for cross-infection control measures to protect against possible routes of transmission frequently ignored in the past. This article is essentially a literature review of cross-infection control measures especially relevant to removable prosthodontic practice. Cross-contamination control measures are considered within the following categories: patient evaluation, personal protection, instrument and equipment contamination, clinical technique, impression handling, and laboratory asepsis.

Health promotion in context: the effects of significant others on health behavior change

Maintenance of health behavior change over the long-term has been routinely difficult. One of the reasons for this difficulty is that only individuals' attitudes or behavior are changed, without concomitant support from the social environment. The purpose of this study was to explore several of the ways in which significant others--family members, friends, and coworkers--may affect changes in health behavior. Eighty-four participants in a work site health promotion program were the subjects of the study. Self-reports of health behaviors were gathered at baseline and at the end of the 7-week program; in addition, subjects reported the extent to which significant others generally supported health behavior changes, encouraged them to maintain changes they had made, and made changes in their own health behaviors. Results provide support for the general hypothesis that one individual attempting to change health behavior may be positively influenced by significant others during the course of the change process. Family members were particularly helpful, and overall supportiveness was more helpful than others' change in health habits or encouragement. Behaviors most influenced by others were exercise and fat consumption. Suggestions for future theoretical development, research, and intervention are discussed.