Excitatory and inhibitory synapses show a tight subcellular correlation that weakens over development.

Neurons receive correlated levels of excitation and inhibition, a feature that is important for proper brain function. However, how this relationship between excitatory and inhibitory inputs is established during the dynamic period of circuit wiring remains unexplored. Using multiple techniques, including in utero electroporation, electron microscopy, and electrophysiology, we reveal a tight correlation in the distribution of excitatory and inhibitory synapses along the dendrites of developing CA1 hippocampal neurons. This correlation was present within short dendritic stretches (<20 µm) and, surprisingly, was most pronounced during early development, sharply declining with maturity. The tight matching between excitation and inhibition was unexpected, as inhibitory synapses lacked an active zone when formed and exhibited compromised evoked release. We propose that inhibitory synapses form as a stabilizing scaffold to counterbalance growing excitation levels. This relationship diminishes over time, suggesting a critical role for a subcellular balance in early neuronal function and circuit formation.

The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R).

INTRODUCTION: Evaluation in healthcare services has become a priority, globally1. The Government of Ireland has highlighted the importance of stakeholder engagement to identify the needs of women in the design and delivery of high-quality health services, driven by necessity rather than financial ability2. The Birth Satisfaction Scale-Revised (BSS-R), an internationally validated tool, and recommended for measuring childbirth satisfaction by the International Consortium for Health Outcomes Measurement (ICHOM)3; however, it has yet to be considered in the Irish context. The aim of the study was to explore birth satisfaction with a sample of new mothers in Ireland. METHODS: A mixed-methods study was conducted including a survey that involved collection of data from the BSS-R 10-item questionnaire from 307 mothers over an 8-week period in 2019, in one urban maternity hospital in Ireland. Quantitative and qualitative data were collected. Qualitative data from the free-text comments of the survey questions were analyzed using content analysis. RESULTS: Overall, women reported positive relationships with their care providers and were satisfied with the communication and support they received, as well as high levels of control and choice. Postnatal care, however, was highlighted as being less satisfactory with staffing levels described as inadequate. CONCLUSIONS: Understanding women's birth experiences and what is important to them could facilitate midwives and other health professionals to improve the quality of their care and develop guidelines and policies that focus on women and their families' needs. The vast majority of women rated their birthing experience as extremely positive. The main elements of care that contributed to a positive birthing experience for women were quality relationships with clinicians, choice and control, and emotional safety.

Instruments measuring practitioner performance of the complete examination and screening of neonates: A systematic review.

AIM: The complete examination and screening of the neonate is a recommended assessment of neonatal well-being conducted by appropriately trained medical, midwifery and nursing personnel at specific intervals during the first 6-week post-birth. Our aim was to identify and critically evaluate instruments that measure practitioner performance of this important assessment of neonatal health. METHODS: Using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology, a systematic review was undertaken. RESULTS: Four studies were identified as suitable for data extraction and analysis. This paper briefly describes the four instruments, discusses and compares the COSMIN analysis and ratings of each instrument. A recommendation for the instrument identified as the most suitable to measure practitioner performance is provided. CONCLUSION: Most instruments were designed by educators to measure the performance of practitioners developing competence in the complete examination and screening of the neonate. Further development and piloting of instruments designed to measure the performance and continuing competence of qualified practitioners of the newborn examination are required.

Multi-synaptic boutons are a feature of CA1 hippocampal connections in the stratum oriens.

Excitatory synapses are typically described as single synaptic boutons (SSBs), where one presynaptic bouton contacts a single postsynaptic spine. Using serial section block-face scanning electron microscopy, we found that this textbook definition of the synapse does not fully apply to the CA1 region of the hippocampus. Roughly half of all excitatory synapses in the stratum oriens involved multi-synaptic boutons (MSBs), where a single presynaptic bouton containing multiple active zones contacted many postsynaptic spines (from 2 to 7) on the basal dendrites of different cells. The fraction of MSBs increased during development (from postnatal day 22 [P22] to P100) and decreased with distance from the soma. Curiously, synaptic properties such as active zone (AZ) or postsynaptic density (PSD) size exhibited less within-MSB variation when compared with neighboring SSBs, features that were confirmed by super-resolution light microscopy. Computer simulations suggest that these properties favor synchronous activity in CA1 networks.

Midwifery students' experiences of objective structured clinical examinations: A qualitative evidence synthesis.

OBJECTIVES: To identify and synthesise the evidence of midwifery students' views and experiences of Objective Structured Clinical Examinations (OSCEs). DESIGN: A qualitative evidence synthesis was undertaken using Thomas and Harden's synthesis methods and reported according to the ENTEREQ guidelines. DATA SOURCES: PubMED, CINAHL Plus, Embase, ERIC, PsycINFO, Social Science Citation Index (via Web of Science) and Scopus were searched from inception to 19th February 2020 and an updated search was performed on 12th May 2021 to identify qualitative and mixed method studies, reporting qualitative data of undergraduate midwifery students' views and experiences of OSCEs. REVIEW METHODS: Studies were independently screened by title and abstract according to a predetermined inclusion and exclusion criteria. Full text review was then conducted independently by two authors. Studies providing qualitative data on undergraduate midwifery students' views and experiences of OSCEs during their midwifery registration education programmes were included. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP) tool. Data synthesis was performed using Thomas and Harden's thematic synthesis method. RESULTS: Eleven studies were identified and included. Thematic synthesis identified 13 descriptive themes which translated into four analytical themes that represented midwifery students' views and experiences of OSCEs: the preparation phase, the assessment phase, the feedback phase and the translation phase. CONCLUSIONS: This synthesis offers insight into undergraduate midwifery students' views and experiences of OSCEs and how they are experienced across four phases. This is determined to be a useful structure to guide midwifery educators and researchers in their consideration of the student experience of OSCEs in the future. Midwifery students in this synthesis reported high levels of nervousness, anxiety, and stress during the OSCE process. The findings reveal that there are a number of controllable factors impacting on midwifery students' feelings of safety in the assessment environment, and that these should be addressed to maximise the advantages that the OSCE has to offer in terms of learning and preparation for clinical practice.

A service evaluation: impact of nurse-led regional familial hypercholesterolaemia service on a hospital adult lipid clinic.

The authors evaluated the impact of genetic screening for familial hypercholesterolaemia (FH) in a lipid clinic cohort of patients with definite and possible FH as defined by the Simon Broome Register (SBR) criteria. METHODS: Patients with a lipid clinic diagnosis of definite and possible FH based on the SBR criteria were referred to a nurse-led regional service for FH genetic testing. FINDINGS: 140 patients were referred for genetic testing. Six had SBR-definite FH due to the presence of tendon xanthomata and 134 had SBR-possible FH. A monogenic FH mutation was detected in all six patients (100%) with SBR-definite FH and in 34 (25%) of patients with possible FH. CONCLUSION: The appropriate use of molecular genetics in a lipid clinic will greatly facilitate the management of hyperlipidaemia and cardiovascular risk since the management of FH patients (National Institute for Health and Care Excellence (NICE) Clinical Guideline 71) is different from non-FH patients (NICE Clinical Guideline 181).

Do reflex comments on laboratory reports alter patient management?

INTRODUCTION: Laboratory comments appended on clinical biochemistry reports are common in the UK. Although popular with clinicians and the public, there is little evidence that these comments influence the clinical management of patients. METHODS: We provided reflex automated laboratory comments on all primary care lipid results including, if appropriate, recommendation of direct referral to the West Midlands Familial Hypercholesterolaemia service (WMFHS). Over a two-year period, the number GP referrals from the Wolverhampton City Clinical Commissioning Group (CCG) to the WMFHS were compared with four comparator CCGs of similar population size, who were not provided with reflex laboratory comments. RESULTS: Over the study period, the WMFHS received more referrals from Wolverhampton GPs (241) than any other comparator CCG (range 8-65) and greater than the combined referrals (172) from all four comparator CCGs. CONCLUSION: Targeted reflex laboratory comments may influence the clinical management of patients and may have a role in the identification of individuals with familial hypercholesterolaemia.