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Background: There are challenges in providing high quality care for children and young people who are admitted to acute medical wards for mental health concerns. Although there is concern that these admissions are increasing, national data describing these patterns are scarce. We aimed to describe trends in these admissions in England over a 10-year period, and to identify factors associated with repeat admission and length of stay., Methods: In this cohort study we used data on all admissions to medical wards in England among children and young people aged 5-18 years from April 1, 2012, to March 31, 2022. We classified admissions for mental health concerns using the Global Burden of Disease Study cause hierarchy. We described national trends in admissions for mental health concerns over time by sex, age, ethnicity, and index of multiple deprivation quintile. We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than 1 week, as well as hazard ratios of repeat admissions, using mixed-effects models., Findings: We identified 342 511 admissions for any cause in children and young people aged 5-18 years in 2021-22 in England, of which 39 925 (11·7%) were for mental health concerns. 21 337 (53·4%) admissions for mental health concerns were due to self-harm. Between 2012-13 and 2021-22, annual admissions for mental health concerns increased from 24 198 to 39 925 (65·0% increase), whereas all-cause admissions increased from 311 067 to 342 511 (10·1% increase). Increases were particularly steep in females aged 11-15 years, rising from 9091 to 19 349 (112·8% increase), and for eating disorders, rising from 478 to 2938 (514·6% increase). In 2021-22, 3130 (7·8%) admissions for mental health concerns lasted longer than 1 week, compared with 12 044 (3·5%) all-cause admissions. Of 239 541 children and young people who were admitted for mental health concerns between 2012-13 and 2021-22, 32 107 (13·4%) had a repeat admission within 6 months. The odds of long-stay admission and hazard ratios for being readmitted were significantly higher for children and young people aged 11-15 years, those who were female, those from less deprived areas, and those with eating disorders than among other groups., Interpretation: We found large increases in the number of children and young people admitted to acute medical wards for mental health concerns over a 10-year period. Further work is needed to understand factors driving these trends and how to improve care for children and young people with mental health concerns admitted to medical wards., Funding: National Institute for Health and Care Research., Competing Interests: Declaration of interests FG has received royalties for the Great Ormond Street Hospital. Manual of Paediatrics, Wiley, and grant funding from the Burdett Trust for Nursing. HR has an editor contract with National Institute for Health and Care Research (NIHR) Journals Library, and is a University College London council member. LDH has received grant funding from NIHR and Ellern Mede School, consultancy fees from the University of Galway, Ireland, an honorarium from NHS England, and funding for conferences from the European Society for Paediatric Gastroenterology and Nutrition, and Excellence in Paediatrics. All other authors declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: To compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings., Study Design: Prospective surveillance study., Methods: Data were collected during a 13-month prospective surveillance study of children and adolescents with ARFID in the UK and Republic of Ireland. Paediatricians reported cases via the British Paediatric Surveillance Unit and psychiatrists through the Child and Adolescent Psychiatry Surveillance System. A follow-up questionnaire was sent at 12 months after a case of ARFID was reported., Results: 319 cases were included, 189 from paediatricians and 130 from C&A psychiatrists. Patients presenting to paediatricians were younger (9.8 years vs 13.7 years), more often male (62.4% vs 43.1%), and had more chronic symptoms (80.4% vs 67.0%), selective eating (63.7% vs 46.6%) and comorbid autism (67.6% vs 50.0%) than to psychiatrists. Psychiatrists saw patients with more fear of aversive consequences from eating (13.1% vs 3.2%), weight loss (76.7% vs 65.0%) and comorbid anxiety (78.2% vs 47.4%). Patients presenting to paediatricians more often received medical monitoring (74.6% vs 53.1%), dietetic advice (83.1% vs 70.0%) and nutritional supplements (49.2% vs 30.0%). At follow-up, both cohorts improved in nutritional status. However, the psychiatric cohort improved more regarding disordered eating behaviours., Conclusions: The presentation and management of ARFID differs across clinical settings. Findings suggest the need to develop clinical pathways for ARFID assessment and management across paediatrics and mental health. Our findings highlight the potential benefits of psychiatric input for some patients with ARFID., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Nasogastric tube (NGT) feeding under physical restraint is a clinical intervention that may be required when a child or young person is medically unstable secondary to restrictive eating., Aim: To explore the experiences of parents when their child receives NGT feeding under physical restraint and understand the effects of this on them., Method: This is a secondary analysis of data from two previous studies on NGT feeding under physical restraint - one in mental health wards and one in children's wards - in which semi-structured interviews had been conducted with patients, staff and parents. For this secondary analysis, the authors thematically analysed 31 transcripts of interviews with parents., Findings: Parents reported a range of emotions which could be conflicting in nature, notably relief and shame. In both studies, parents understood the necessity of NGT feeding under physical restraint but experienced the intervention as traumatic. They expressed empathy for staff facilitating the restraint. In the children's wards study, some parents described conflict and damaged relationships with staff, and three parents had participated in physically restraining their child for NGT feeding., Conclusion: Nursing staff should be aware that NGT feeding under physical restraint is distressing for parents. Adopting a trauma-informed framework may help to mitigate the traumatic effects on parents and, in turn, on their child., Competing Interests: None declared, (© 2025 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale., Aims: To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK., Method: A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK., Results: A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care., Conclusions: This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.

Electron backscatter diffraction (EBSD) has developed over the last few decades into a valuable crystallographic characterisation method for a wide range of sample types. Despite these advances, issues such as the complexity of sample preparation, relatively slow acquisition, and damage in beam-sensitive samples, still limit the quantity and quality of interpretable data that can be obtained. To mitigate these issues, here we propose a method based on the subsampling of probe positions and subsequent reconstruction of an incomplete data set. The missing probe locations (or pixels in the image) are recovered via an inpainting process using a dictionary-learning based method called beta-process factor analysis (BPFA). To investigate the robustness of both our inpainting method and Hough-based indexing, we simulate subsampled and noisy EBSD data sets from a real fully sampled Ni-superalloy data set for different subsampling ratios of probe positions using both Gaussian and Poisson noise models. We find that zero solution pixel detection (inpainting un-indexed pixels) enables higher-quality reconstructions to be obtained. Numerical tests confirm high-quality reconstruction of band contrast and inverse pole figure maps from only 10% of the probe positions, with the potential to reduce this to 5% if only inverse pole figure maps are needed. These results show the potential application of this method in EBSD, allowing for faster analysis and extending the use of this technique to beam sensitive materials., (© 2025 The Author(s). Journal of Microscopy published by John Wiley & Sons Ltd on behalf of Royal Microscopical Society.)

Despite the widespread use of Scanning Transmission Electron Microscopy (STEM) for observing the structure of materials at the atomic scale, a detailed understanding of some relevant electron beam damage mechanisms is limited. Recent reports suggest that certain types of damage can be modelled as a diffusion process and that the accumulation effects of this process must be kept low in order to reduce damage. We therefore develop an explicit mathematical formulation of spatiotemporal diffusion processes in STEM that take into account both instrument and sample parameters. Furthermore, our framework can aid the design of Diffusion Controlled Sampling (DCS) strategies using optimally selected probe positions in STEM, that constrain the cumulative diffusion distribution. Numerical simulations highlight the variability of the cumulative diffusion distribution for different experimental STEM configurations. These analytical and numerical frameworks can subsequently be used for careful design of 2- and 4-dimensional STEM experiments where beam damage is minimised., (© 2024 The Author(s). Journal of Microscopy published by John Wiley & Sons Ltd on behalf of Royal Microscopical Society.)