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The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves.Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes.A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p0.001).Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

This paper will review faculty development focus and programming at the early, mid and late career stages. Topics covered include challenges at each career stage, institutional and national programming currently available for the needs of faculty at that stage, and suggested best practices for development of new career focus and potential programs for each stage.

Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.

Structured reports offer overall improvement in quality and safety, largely centered upon more effective communication. Structured reporting is helpful to trainees as a method to develop organized search patterns and include pertinent positive and negative findings. However, limitations of structured report use include lack of development of individualized search patterns and failure to recognize key elements of the report to be formulated in the impression. Instruction on the value of a structured reporting approach, its impact on patient care and clinical service, and compliance with billing requirements must be balanced with early and consistent feedback on appropriate use and reporting errors. It is incumbent upon radiology educators to integrate and optimize structured reporting in the learning environment. This manuscript addresses the impact of structured reporting on radiology education, reviewing quality and safety considerations, detailing benefits and drawbacks for trainees, and offering strategies for optimizing the use of structured reporting/templates in the training environment.

Rationale Three years ago, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated Common Program Requirements in recognition of the need to further promote resident and faculty member well-being and patient safety. The ACGME acknowledged residencies would need time to comply with new requirements. This grace period, however, concluded as of July 1, 2019, and programs now risk citations for failure to implement new requirements. Methods and Results The authors, members of the Association of Program Directors in Radiology Common Program Requirements Ad Hoc committee, developed downloadable resources provided in the Appendix delineating the 2019 Common Program Requirements and offering sample resources as compliant solutions. Conclusion The resources offer a national standardized approach to educating trainees in these essential skills and should be especially helpful to programs with access to fewer resources. In addition to achieving compliance, incorporation of these resources into residency training will ensure the next generation of radiologists are equipped to add value while remaining physically and emotionally healthy.

The Accreditation Council for Graduate Medical Education oversees graduate medical education in the United States. Designed to provide broad based training in all aspects of imaging, the diagnostic radiology residency program must provide educational experiences that not only provide technical, professional, and patient centered training, but also meet accreditation standards. With the breadth of material to cover during training, carefully orchestrated educational experiences must be planned. This manuscript offers residency program leaders resources to meet the challenges of the new Accreditation Council for Graduate Medical Education Diagnostic Radiology Milestones 2.0 and highlights potential opportunities for future educational endeavors.

Polysaccharide scaffolds have been successfully employed to reconstruct environments that sustain skin tissue regeneration after injuries. Three-dimensional (3D) advanced additive manufacturing technologies allow creating scaffolds with controlled and reproducible macro- and micro-structure that improve the quality of the restored tissue to favor spontaneous repair. However, when persistent inflammation occurs, the physiological tissue healing capacity is reduced, like in the presence of pathologies like diabetes, vascular diseases, chronic infection, and others. In these circumstances, the bioavailability of therapeutic adjuncts like the growth factors in addition to the standard treatments represents undoubtedly a promising strategy to accelerate the healing of skin lesions. Precisely designed polysaccharide scaffolds obtained by 3D printing represent a robust platform that can be further implemented with the controlled delivery of bioactive adjuncts. Human elastin-like polypeptides (HELPs) are stimuli-responsive biopolymers. Their structure allows the integration of domains endowed with biological functionality, making them attractive compounds to prepare composites with smart properties. In the present study, 3D-printed alginate and chitosan scaffolds were combined with the HELP components. The HELP biopolymer was fused to the epidermal growth factor (EGF) as the bioactive domain. Different constructs were prepared and the stimuli-responsive behavior as well as the biological activity were evaluated, suggesting that these smart bioactive composites are suitable to realize multifunctional dressings that sustain the local release of therapeutic adjuncts.

Supplemental Material for Applying an Established Exposure Response Prevention Protocol for Young People With Tourette Syndrome in an Intensive, Group Format: A Feasibility Study by Maria Hadji-Michael, Matteo Catanzano, Eve McAllister, Isobel Heyman, Oliver Lack, Tara Murphy, and Jane Gilmour in Clinical Child Psychology and Psychiatry.

Introduction: Years of tissue engineering research have clearly demonstrated the potential of integrating growth factors (GFs) into scaffolds for tissue regeneration, a concept that has recently been applied to wound dressings. The old concept of wound dressings that only take a passive role in wound healing has now been overtaken, and advanced dressings which can take an active part in wound healing, are of current research interest.\ud \ud Areas covered: In this review we will focus on the recent strategies for the delivery of GFs to wound sites with an emphasis on the different approaches used to achieve fine tuning of spatial and temporal concentrations to achieve therapeutic efficacy.\ud \ud Expert opinion: The use of GFs to accelerate wound healing and reduce scar formation is now considered a feasible therapeutic approach in patients with a high risk of infections and complications. The integration of micro – and nanotechnologies into wound dressings could be the key to overcome the inherent instability of GFs and offer adequate control over the release rate. Many investigations have led to encouraging outcomes in various in vitro and in vivo wound models, and it is expected that some of these technologies will satisfy clinical needs and will enter commercialization.

RadExam is a question item and exam database jointly developed by the Association of Program Directors in Radiology and the American College of Radiology to provide formative resident assessment, offering performance metrics benchmarked against institutional and national resident performance. Beyond resident performance, data is available on question and exam performance. Despite considerable investment in the education and training of its question writers and editors and meticulous attention to current psychometrically validated methods, it was anticipated a minority of exam questions would still perform poorly. Audits were performed to identify these questions, identify reasons for poor performance, and modify or replace so-affected questions. Exam performance was also assessed.Two audits were performed, the first after the February-May 2018 RadExam pilot phase, and the second nearly 1 year after the full implementation of RadExam. In each audit, RadExam subspecialty editors evaluated all exam questions and exams using statistical data: question and test number of administrations, question p value, question Discrimination Index (DI), question Bloom's taxonomy learning level, exam P-value, and the number of image-based questions in each exam. Identified questions were modified or removed and replaced.Audit 1 was performed after the administration of 3114 exams comprised of 2520 questions administered across 100 residency programs. Audit 1 identified 617 questions with DI0.1 and 565 questions with unacceptable P-values, all of which were modified or replaced. Audit 2 was performed after the administration of 16,416 exams, comprised of 2,507 questions. Audit 2 identified 229 questions with DI0.1 and 290 questions with unacceptable P-values, representing a 49.1% decrease in total flagged questions compared to Audit 1. Statistically significant decreases were seen in questions with both DI and P-values outside of the desired range across nearly all subspecialties.The positive impact of our audit system on question and exam performance was reflected in a significant decrease in the number of questions flagged and improved overall exam performance in Audit 2. This illustrates the positive impact of Audit 1.

This article reviews current medical literature to assess the benefits and drawbacks of virtual interviews for radiology residencies as well as the downstream effects of these changes, best practices, and potential future recruitment methods. Topics covered include the effects of remote recruitment in promoting accessibility and applicant diversity and equality as well as fiscal, environmental, and time savings in combination with technical challenges, the complications of over application, challenges in assessment of program culture and location, impact on morale, and hidden financial and emotional costs. Learnings from other medical specialties are highlighted in addition to the process of signaling, guidelines for conducting and participating in virtual interviews, and matters for future consideration.

BackgroundChildren and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.ObjectiveA non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.Methods186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital’s paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.FindingsThere was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen’s d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen’s d=0.55).ConclusionsA mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.Clinical implicationsDrop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.

Injuries to the liver and biliary tree carry significant morbidity and mortality if not diagnosed and managed rapidly. As clinical evaluation of suspected hepatobiliary injury is often limited in traumatic or post-surgical settings, imaging plays a critical role in the diagnosis of injury, assessment of treatment response and detection of delayed complications. In this paper, we review acute traumatic and iatrogenic hepatobiliary injuries and subsequent complications through different imaging modalities.

Rationale and Objectives An increase in the administrative work in our healthcare system has led to an increase in the number of administrative positions in radiology departments. Many of these are Vice Chair roles, including Vice Chair for Education (VCEd). The responsibility of this position has expanded, often far beyond the original definition. This article defines the role and expectations of the Vice Chair for Education and provides suggestions for success. Materials and Methods This article will review 12 vital roles that a Vice Chair for Education must play to be an effective advocate for radiology education within a department. Results Key attributes of an educational leader are delineated, divided into 12 areas or roles. Conclusion This article summarizes key leadership skills needed by Vice Chairs for Education in order for them to be effective in their role.

This article will review critical components for the successful completion of a multi-institution, multiauthor collaborative paper. Best practices for the creation and publication of a collaborative paper will be addressed.

Trevicta audit

Common chronic physical illnesses in children include asthma, eczema, and diabetes. Some chronic physical illnesses, particularly neurological conditions, are associated with increased rates of intellectual and/or neurodevelopmental disabilities such as autism spectrum disorder. Rates of mental health disorders are elevated in children with a chronic physical illness compared to children who are otherwise healthy. The most common mental health disorders in this group are the same as the most common in children without a chronic physical illness: anxiety disorders, depressive disorders, and disruptive behaviour disorders. This chapter describes how low intensity and/or brief interventions may be used to treat these common mental health disorders in the context of chronic physical illness.

Communication is vital in healthcare to facilitate the best patient care at all times. During the COVID-19 pandemic, communication has become increasingly crucial, including devising innovative, novel, and effective ways to exchange information in graduate medical education, multidisciplinary teams, and patient care, all which affect our learners. This article will provide a comprehensive review of generational characteristics, including communication preferences. Effective communication strategies and communication challenges with learners (millennial generation) will be discussed in detail.

Background The motor and vocal tics that characterise Tourette syndrome are stigmatizing and impact on quality of life. Behavioural interventions such as Exposure Response Prevention or Comprehensive Behavioural Interventions for Tics are first line treatment for Tourette syndrome, but availability is limited. This study is the first to explore the impact of an established manualised Exposure Response Prevention treatment protocol, developed for individual therapy, but here uniquely delivered intensively, to a group. Methods A naturalistic study comprised of a consecutive series of children ( N = 20), aged 8–16 years (M = 12, SD = 2.17) were offered Exposure Response Prevention in one of two groups, delivered in series within a specialist clinic. Young people received the equivalent of 12 sessions (matching the manualised individual protocol). Results The YGTSS and Giles de la Tourette Syndrome Quality of Life Scale for Children and Adolescents (Satisfaction Scale) showed significant improvement following treatment with moderate to large effect sizes. Thirty-five percent of children demonstrated a reliable improvement on the YGTSS Global Tic Severity score. Conclusions These data suggest an established Exposure Response Prevention protocol can be delivered in an intensive, group setting with a positive clinical outcome. Replication in a randomized controlled trial is an important next step.

Prompt diagnosis of pulmonary embolism is essential to avert morbidity and mortality. There are a number of diagnostic options for identification of a pulmonary embolism, including laboratory and imaging investigations. While computed tomography pulmonary angiography (CTPA) has largely supplanted nuclear medicine ventilation/perfusion studies, there remain significant limitations in the optimal performance of CTPA. Dual-energy computed tomography has the ability to overcome many of the limitations of standard of care CTPA, including rescue of poor contrast boluses and the ability to evaluate pulmonary perfusion defects.

Midcareer faculty development is critical for continued career vitality and retention. However, limited formal programming exists to meet the needs of this group, which is at risk of experiencing a lack of career self-identity and a sense of being stuck. These feelings may lead radiologists to consider a change in practice type or location or even to exit the radiologist workforce. This viewpoint describes stressors and potential solutions to assist midcareer radiologists in regaining workplace engagement.

Retrospective cohort study. To investigate radiographic sagittal and spinopelvic parameters of patients with adolescent idiopathic scoliosis (AIS) treated with bracing and assess differences among those treated successfully and unsuccessfully. AIS is a three-dimensional deformity of the spine, sharing an intricate relationship with pelvic morphology. However, the most relevant predictors of curve progression have historically been coronal parameters and skeletal maturity. Sagittal and spinopelvic parameters have not been thoroughly investigated as predictors of curve progression and brace treatment success. Retrospective review of AIS patients who underwent brace treatment. Coronal Cobb angles (CC), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and thoracic spinopelvic angles (T1SP, T9SP) were measured prior to initiation of bracing. The sagittal and spinopelvic parameters of patients requiring surgical treatment due to curve progression were compared to those treated successfully with bracing. No significant differences were found for age, race, gender, Risser category (0/1 vs 2/3), initial CC, TK, LL, T1SP, or T9SP between cohorts. The cohort requiring surgery had significantly lower PI (p < 0.001, 42.0 v. 54.6), SS (p < 0.001, 37.0 v. 44.5), and PT (p = 0.003, 5.0 v. 10.2) compared to those successfully treated with bracing. Multivariable models controlling for Risser stage and Initial CC revealed the odds for successful brace treatment increases with an increase in PI (OR = 1.47, CI 1.18–1.83, p < 0.001), SS (OR = 1.26, CI 1.07–1.48, p = 0.006), and PT (OR = 1.43, CI 1.09–1.86, p = 0.006) (Table 3). The odds of successful brace treatment is given per one-unit increase for each radiographic measure after adjusting for Initial CC and Risser sign which were forced into each multivariable model. Spinopelvic parameters may indicate potential spine adaptability and skeletal maturity. For these reasons, we proposed that spinopelvic parameters may be a potential predictor of curve progression and brace treatment success. Our results demonstrated a higher risk of curve progression with lower PI, PT, or SS which support this hypothesis, however, given the small sample size and high variability, the magnitude of this effect should be viewed with caution and should serve as an impetus to further, larger scale studies to investigate the value spinopelvic parameters in curve progression and bracing efficacy. IV.

Transitioning from radiology training to academic faculty presents many challenges. In this review, we discuss strategies to navigate this process and to facilitate success through appropriate selection of career tracks. Various modern avenues include roles as a Clinician-Educator, Clinician-Investigator, and Clinician-Administrator. Selection of the appropriate career track based on personal interests and institutional culture is critical for early and long-term career satisfaction.

This article will familiarize the reader with useful tools and trouble-shooting tips for web-based conferencing. Radiology-based scenarios for web conferencing are also provided.

Transitioning from radiology residency to academic faculty presents many challenges. In this review, we discuss the importance of introspection and mentorship to successfully navigate this process. Key points include alignment of goals with those of the institution, formation of a mentorship program, and periodic reassessment of career goals. These tips and tools can help make the transition from residency to academic faculty more seamless.

PURPOSE It has been recently shown that radiotherapy at ultrahigh dose rates (>40 Gy/s, FLASH) has a potential advantage in sparing healthy organs compared to that at conventional dose rates. The purpose of this work is to show the feasibility of proton FLASH irradiation using a gantry-mounted synchrocyclotron as a first step toward implementing an experimental setup for preclinical studies. METHODS A clinical Mevion HYPERSCAN® synchrocyclotron was modified to deliver ultrahigh dose rates. Pulse widths of protons with 230 MeV energy were manipulated from 1 to 20 μs to deliver in conventional and ultrahigh dose rate. A boron carbide absorber was placed in the beam for range modulation. A Faraday cup was used to determine the number of protons per pulse at various dose rates. Dose rate was determined by the dose measured with a plane-parallel ionization chamber with respect to the actual delivery time. The integral depth dose (IDD) was measured with a Bragg ionization chamber. Monte Carlo simulation was performed in TOPAS as the secondary check for the measurements. RESULTS Maximum protons charge per pulse, measured with the Faraday cup, was 54.6 pC at 20 μs pulse width. The measured IDD agreed well with the Monte Carlo simulation. The average dose rate measured using the ionization chamber showed 101 Gy/s at the entrance and 216 Gy/s at the Bragg peak with a full width at half maximum field size of 1.2 cm. CONCLUSIONS It is feasible to deliver protons at 100 and 200 Gy/s average dose rate at the plateau and the Bragg peak, respectively, in a small ~1 cm2 field using a gantry-mounted synchrocyclotron.

Advances in technology have resulted in the significant growth of web-based conferencing and teaching. While these remote sessions have many advantages, they may result in challenges and frustration for both host and attendees when there are technological issues, poor or distracting audio, or ineffective presentation styles. Knowing a few basic concepts behind web conferencing and preparing in advance can markedly improve the experience and facilitate effective distance learning and collaboration.

Although radiologic imaging of bowel infections is often a precursor to definitive diagnosis by endoscopy, biopsy, or stool cultures, imaging can provide critical information for diagnosis and management. Many infectious entities such as viral, bacterial, and parasitic infections can be discovered on imaging. Furthermore, imaging characterizes the extent of infection, involvement of specific bowel segments, and presence of complications in the abdomen. Utilizing a multimodality approach using ultrasound, computed tomography, and magnetic resonance imaging, we describe the spectrum of imaging findings that distinguish a number of infectious etiologies that affect the bowel, as well as differentiate from ischemic and inflammatory bowel processes.

Infections of the male and female reproductive system can lead to significant morbidity and mortality. This article will review the relevant embryology and anatomy of the male and female reproductive systems and will discuss the imaging findings of different infections. An understanding of the clinical presentation and imaging findings of infections of the reproductive system is critical in order to allow for prompt and accurate diagnosis. A delay in diagnosis for these infections can have significant morbidity, and occasional mortality.

Acute urinary tract infection diagnosis is primarily performed on clinical grounds. Diagnostic imaging is, however, often necessary as part of the workup for poor response to treatment, to evaluate causative or contributory factors, complicated infections and chronic presentations. Appropriate knowledge of the most relevant radiological findings in urinary tract infections provides pertinent differential diagnosis and guides clinical management, including emergent and aggressive interventions. In this article we review ultrasound and CT imaging findings of acute and chronic urinary tract infections.

Hepatobiliary infections account for a small but clinically important proportion of emergency department presentations. They present a clinical challenge due to the broad range of imaging characteristics on presentation. Recognition of complications is imperative to drive appropriate patient care and resource utilization to avoid diagnostic pitfalls and avert adverse patient outcomes. A thorough understanding of anatomy infectious pathology of hepatobiliary system is essential in the emergency setting to confidently diagnose and guide medical intervention. Many presentations of hepatobiliary infection have characteristic imaging features on individual imaging modalities with others requiring the assimilation of findings of multiple imaging modalities along with incorporating the clinical context and multispecialist consultation. Familiarity with the strengths of individual imaging modalities in the radiologists' arsenal is imperative to guide the appropriate utilization of resources, particularly in the emergent time sensitive setting. Accurate identification and diagnosis of hepatobiliary infections is vital for appropriate patient care and management stratification.

As 2-year follow-up may not be sufficient to assess the risk of curve progression following fusion in immature patients with adolescent idiopathic scoliosis (AIS), this study reports on 5-year outcomes of AIS patients, factoring in maturity and surgical approach, to determine whether immature patients are at risk of continued curve progression beyond 2 years.A multicenter database was reviewed for AIS patients who underwent spinal fusion with pedicle screw fixation and who had both 2 and 5-year follow-up. Radiographic and SRS-22 scores were compared between three groups: open triradiate cartilage-posterior fusion (OTRC-P), OTRC-combined anterior/posterior fusion (OTRC-APSF), and closed TRC (CTRC, matched to OTRC-P group).142 subjects were included (67 OTRC-P, 8 OTRC-APSF, 67 CTRC). Main curve type (p = 0.592) and size (p = 0.117) were not different between groups at all timepoints. Compensatory curve size was similar at all timepoints for OTRC-P and CTRC, with a slight increase for OTRC-APSF from immediate postoperative to 5 years. At 5 years, OTRC-P had 10° loss of correction in 25% of patients, which was greater than in the CTRC (6%) and OTRC-APSF (0%) groups (p = 0.002). No significant differences were found in loss of correction of the compensatory curve or in SRS-22 scores between groups.Compared to those with CTRC and those treated with anterior/posterior fusion, patients with OTRC treated with posterior fusion had an increased risk of main curve progression greater than 10°, with some continued loss of correction after 2 years. This did not appear to affect patient-reported outcomes.

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings. Key learning aims (1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions. (2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties. (3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care.

Additional file 1: Appendix A. Patient Characteristics from the OutcomeStudy. Appendix B. Base-case Model ICER Scatter Plot. Appendix C. Practical Model ICER Scatter Plot.

This contribution reports the design, synthesis, photochemical properties and drug inclusion capability of two novel β-cyclodextrin (βCD) conjugates, βCD-NBFNO1 and βCD-NBFNO2, covalently integrating an N-nitroso amino-nitro-benzofurazan in the primary and secondary hydroxyl rims of the βCD scaffold, respectively through flexible spacers of different length. Both βCD conjugates are water-soluble and release nitric oxide (NO) under the input of either blue or green light, with quantum yields ΦNO (blue) = 0.13, 0.31 and ΦNO (green) = 0.007, 0.013 respectively, the former representing the largest values ever reported for nonmetal-containing NO donors activatable by visible light. The good contrast between the fluorescence green emission of the chromogenic moiety after and before the NO release permits the easy and in real-time quantification of the amount of NO generated, without the addition of external fluorescent agents. Despite the presence of the appendages, these βCD derivatives are also able to complex betaxolol, a β-blocker drug widely used for the reduction of the intraocular pressure, with binding constants Kb = 500 ± 50 and 1100 ± 100 M−1, respectively, without affecting the photochemical performances. In view of the well-known vasodilator properties of NO, the present βCD derivatives represent intriguing candidates for biopharmaceutical research studies addressed to combined therapeutic ocular applications.