Changes in proteomic cargo of circulating extracellular vesicles in response to lifestyle intervention in adolescents with hepatic steatosis.

Background: Recent studies suggest that proteomic cargo of extracellular vesicles (EVs) may play a role in metabolic improvements following lifestyle interventions. However, the relationship between changes in liver fat and circulating EV-derived protein cargo following intervention remains unexplored.

Methods: The study cohort comprised 18 Latino adolescents with obesity and hepatic steatosis (12 males/6 females; average age 13.

Clinically elevated depression scores do not produce negative attentional biases in caregivers of autistic children.

Objective: Depression scores in caregivers of autistic children often fall in the clinical range. The attention of clinically depressed individuals tends to be biased toward negatively toned information. Whether caring for an autistic child might also be characterized by a negative attentional bias was explored here.

Social support mediates the relationship between dispositional gratitude and psychological distress in caregivers of autistic children.

Grateful caregivers report lower levels of psychological distress. Social support, engendered by gratitude and buffering against stress, might mediate this effect. Here we explored whether the protective psychological effect of dispositional gratitude might be mediated by increased social support.

Seeing it my way: A perspective taking intervention alleviates psychological distress in caregivers of autistic children.

Cognitively empathic caregivers are able to take the perspective of their autistic child(ren) without experiencing vicarious distressing emotions, and typically report lower psychological distress. Taking the perspective of the autistic child might, through fostering cognitive empathy, might relieve caregivers' psychological distress. Here we explored whether autism perspective taking videos developed by the National Autistic Society (NAS), intended to raise public awareness about autism, might be effective, packaged as an intervention, for increasing caregivers' cognitive empathy and reducing their psychological distress.

The voices of incarcerated women at the forefront of parenting program development: a trauma-informed approach to education.

Background: The lives of women experiencing incarceration are complex, impacting many aspects of parenting. Incarceration can present an opportunity for women to access parenting education. However, their specific needs have to be considered.

A Qualitative Evaluation of a Simulation Training Initiative for Registrars Working in Acute Medicine.

Introduction: We evaluated a simulation-based training day for medical registrars to define the hidden curriculum of the training.

Methods: We interviewed participants to explore their reflections about the day, what they had learned and how it had influenced their practice. Interviews were conducted iteratively and analysed in accordance with content thematic analysis.

Editorial - Evolve, Adapt, Innovate and Deliver: Acute Medicine post COVID pandemic.

Predictions for acute care in the upcoming months are difficult. There will be challenges: there always are and that to a degree is what makes working in acute care so fulfilling. However, even the most adaptive and innovative acute care systems will toil when these challenges become overwhelming.

Editorial - Managing Risk in Uncertain Times.

In February 2021 Jon Hilton (AIM ST4 doctor) published a tweet asking about how the Acute Medicine community can best address potential applicant's fears of dealing with clinical risk. Appraising and managing risk is at the core of acute medical clinical practice; we treat patients in the first crucial 24 hours of their hospital journey, when the clinical status is changeable, and the clinical trajectory not yet established. We make judgement calls about medical treatment, but also about whether a patient can be safely discharged home, and this often causes anxiety amongst less experienced clinicians: how do you make that call?

Sleep disturbances and physical health problems in caregivers of children with ASD.

Objectives: Caregivers of children with autism spectrum disorder self-report more physical health problems than controls. Sleep disturbances are also more prevalent in caregivers, and are positively associated with physical health problems. The negative impact of caring for a child with ASD on physical health therefore, might occur indirectly via poorer sleep.

Editorial - We are all story-tellers.

Story telling is a human universal. It is as old as language. Creating and relating narratives form an integral part of how physicians understand and communicate about our patients and their diseases.

The Parenting Education Needs of Women Experiencing Incarceration in South Australia: Proposal for a Mixed Methods Study.

Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated.

Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia.

Editorial - Decision-making in acute medicine.

Acute physicians make patient-centred decisions at the start of the patient's hospital journey. Dozens more decisions are made by the individual members of the MDT (and, of course, by the patient) during the in-patient period. Decisions are made at every level of seniority and experience and range widely in scope and impact.

Exploring Inter-Instance Relationships within the Query Set for Robust Image Set Matching.

Image set matching (ISM) has attracted increasing attention in the field of computer vision and pattern recognition. Some studies attempt to model query and gallery sets under a joint or collaborative representation framework, achieving impressive performance. However, existing models consider only the competition and collaboration among gallery sets, neglecting the inter-instance relationships within the query set which are also regarded as one important clue for ISM.

Exploring the Moderating Role of Benefit Finding on the Relationship Between Child Problematic Behaviours and Psychological Distress in Caregivers of Children with ASD.

Caregivers of children with ASD often find benefits associated with their caregiving role, and benefit finding predicts lower distress. Child problematic behaviours (CPB), which positively predict caregivers' distress, are perceived to be being less problematic, or more manageable, by caregivers who find benefits. Benefit finding therefore might mitigate the negative psychological impact of CPB.

Affiliate stigma, perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study.

Background: Affiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored.

Methods: A correlational design was used.

Objectively assessed prospective memory failures and diurnal cortisol secretion in caregivers of children with ASD.

Caregivers of children with autism spectrum disorder (ASD) self-report more prospective memory (PM) failures compared with controls. Subjective and objective measures of PM, however, tend to be poorly correlated. This study therefore explored the cognitive impact of caring for a child with ASD using the Cambridge Prospective Memory Test (CAMPROMPT), a more objective, performance-based assessment of PM failures.

Caregivers' characteristics and family constellation variables as predictors of affiliate stigma in caregivers of children with ASD.

Affiliate stigma is one risk factor for psychological distress in familial caregivers. Few studies however, and none involving caregivers in the UK and US, have explored caregivers' characteristics and family constellation variables as risk and protective factors for affiliate stigma. This study aimed to fill this gap.

Editorial - Acute Medicine is invested in patient care, and therefore multiple departments.

There is a myth that Acute Physicians only work in Acute Medical Units (AMUs). In fact, they tread a constant path between the AMU, the Emergency Department (ED), ambulatory care, Intensive Care Units (ITUs) and various specialty wards within the hospital. Just as our focus is not tied to a single organ or body system, is it not solely linked to a certain geographical place.

Editorial - An increasing global footprint.

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries.

Multi-Modal Joint Clustering With Application for Unsupervised Attribute Discovery.

Utilizing multiple descriptions/views of an object is often useful in image clustering tasks. Despite many works that have been proposed to effectively cluster multi-view data, there are still unaddressed problems such as the errors introduced by the traditional spectral-based clustering methods due to the two disjoint stages: 1) eigendecomposition and 2) the discretization of new representations. In this paper, we propose a unified clustering framework which jointly learns the two stages together as well as utilizing multiple descriptions of the data.

Editorial - Delivering and transforming, but many questions and challenges remain.

Acute Medicine remains a specialty in its infancy and, as such, faces many challenges associated with developing new ways of working. As the Society for Acute Medicine celebrates its 18th birthday the extraordinary role of Acute Medicine in both maintaining and indeed enhancing the care and welfare of patients is increasingly evident. However, scepticism still persists among some colleagues with regards to its effectiveness - a perception heightened by the difficult environment that currently pervades in acute and emergency care in the UK which mirrors the experience of many countries internationally.

Editorial - Assessing, treating and prognosticating from the front door.

In our daily working lives, acute physicians strive to provide the best holistic care to our patients from the moment they arrive in hospital. Experienced healthcare professionals develop a gut feeling (generally recognised as the nagging internal voice of professional experience) about patients who may be more unwell than appearances suggest, or who may deteriorate despite showing signs of physiologically compensating quite well. The papers in this issue challenge us to examine how we prioritise, prognosticate and risk-stratify the patients we treat in acute medicine, how we remain cognisant and skilled in treating patients with more unusual acute medical conditions, and how we allocate resources in the NHS.