Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border.

Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS: The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.

Antecedentes: Los horrores que están ocurriendo en la guerra en Ucrania han conducido a consecuencias tremendas en términos de pérdidas de vidas, heridas graves, y de movimientos masivos de ciudadanos. Vivir en zonas de conflicto, estar expuestos a la guerra y ser forzados a desplazarse, aumenta el riesgo de experimentar un amplio espectro de consecuencias directas e indirectas sobre la salud física y mental de las poblaciones afectadas, especialmente en los niños.Objetivo: Esta carta al director busca proveer múltiples perspectivas clínicas y de sistemas de apoyo psicosocial y de salud mental en servicios de urgencia (MHPSS, por sus siglas en inglés) en relación a los esfuerzos de ayuda que se están realizando, y discutirlos con una perspectiva de asistencia informada sobre el trauma, para conectar y diseminar las actuales observaciones de las prácticas clínicas y MHPSS involucradas en la respuesta de salud mental actual.Resultados y discusión: Las diversas perspectivas de tres profesionales de la salud mental involucrados en la respuesta de los MHPSS destacan las diferentes cargas y necesidades de niños que han sido confrontados con situaciones de naturaleza existencial. Los niños viviendo situaciones sociales en transformación, condiciones de vida deterioradas y la incertidumbre general al encontrarse con numerosas pérdidas. Como tal, la guerra es el máximo estresor existencial no normativo. Los cuatro puntos de vista destacan la necesidad de: (1) ajustar la ayuda según las necesidades del beneficiario, (2) comprender los esfuerzos de ayuda como encuentros humanos intersubjetivos e incluir en ellos a los padres y cuidadores, (3) reconocer las pérdidas y adoptar la búsqueda de maneras para facilitar el duelo, y (4) continuar abordando estas necesidades de una forma coordinada que siga guías clínicas interinstitucionales.Conclusión: Una mejor comprensión de las necesidades de los niños refugiados subraya la importancia de invertir en su futuro proveyéndolos de recursos de ayuda humanitaria e intervenciones psicosociales durante emergencias prolongadas. Estas perspectivas presentadas en esta carta enfatizan que el cuidado psicosocial está profundamente arraigado en encuentros de ayuda intersubjetivos y, por lo tanto, debería ocurrir una profesionalización de las intervenciones junto con su humanización, y ser adaptados a las necesidades subjetivas, a los trasfondos socioculturales variados, y a los individuos mismos con el objetivo de disminuir el sufrimiento y fomentando el bienestar.

Microstructured barbs on the North American porcupine quill enable easy tissue penetration and difficult removal.

North American porcupines are well known for their specialized hairs, or quills that feature microscopic backward-facing deployable barbs that are used in self-defense. Herein we show that the natural quill's geometry enables easy penetration and high tissue adhesion where the barbs specifically contribute to adhesion and unexpectedly, dramatically reduce the force required to penetrate tissue. Reduced penetration force is achieved by topography that appears to create stress concentrations along regions of the quill where the cross sectional diameter grows rapidly, facilitating cutting of the tissue. Barbs located near the first geometrical transition zone exhibit the most substantial impact on minimizing the force required for penetration. Barbs at the tip of the quill independently exhibit the greatest impact on tissue adhesion force and the cooperation between barbs in the 0-2 mm and 2-4 mm regions appears critical to enhance tissue adhesion force. The dual functions of barbs were reproduced with replica molded synthetic polyurethane quills. These findings should serve as the basis for the development of bio-inspired devices such as tissue adhesives or needles, trocars, and vascular tunnelers where minimizing the penetration force is important to prevent collateral damage.