The formation of nitrogen-fixing nodules on roots of leguminous plants by Rhizobium spp. involves a complex interaction between host plant and symbiont. Successful nodulation requires the coordinated expression of several nodulation (nod) genes in the bacteria. The expression of these genes is induced by flavonoid compounds present in root exudates of host plants. Growth of Rhizobium spp. and formation of nodules on roots of leguminous plants is known to be adversely affected by low pH and factors associated with soil acidity, but the basis of this acid-sensitivity is poorly understood. We consider that poor induction of nodulation gene expression in Rhizobium is a major factor contributing to the acid-sensitivity of nodulation formation. At low pH, induction of nod gene expression in R. leguminosarum biovar trifolii is markedly reduced in the presence of flavone-inducer. Furthermore, inducibility of nod gene expression in R. leguminosarum bv. trifolii is also affected by a net reduction in the concentration of nod gene-inducing factors present in the root exudates of clover seedlings grown in acidic conditions.

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AimsTo evaluate the use of an adolescent psychosocial screening tool (HEEADSSS assessment) on admission to hospital. To identify barriers to screening and inform service development.MethodsA retrospective evaluation of a systematic sample of 10–18 year olds admitted over a six month period. Case notes were reviewed to identify the recording of the components of the HEEADSSS assessment. We included an equivalent number of young people admitted with mental health as well as physical health presentations. We asked the medical team to identify barriers to using the HEEADSSS tool when admitting young people to the acute paediatric ward via an electronic survey.ResultsWe identified 60 young people (mean 13.9 years), 30 admitted with a mental health presentation, and 30 with ‘other’ acute presentations. Overall 25% (15/60) had a fully completed HEEADSSS tool, with 57% (34/60) partially completed, and absent in 18% (11/60). In young people presenting with mental health problems 47% (14/30) had a completed HEEADSSS, occurring in only 3% (1/30 patient) in the ‘other’ category (chi squared 15.02 p<0.0001). In the ‘other’ group 18/30 (60%) had a partially completed HEEADSSS, and absent in 37%. Of those presenting with a ‘mental health’ problem, 16/30 (53%) had a partially completed assessment (Fisher’s Exact Test p=0.0001). Overall the components least frequently documented were Eating (13%), Safety (30%), Activities (35%) and Sex (37%). Barriers to completion included family members being present, the engagement of the young person, lack of familiarity/training using HEEADSSS, and the hospital environment.ConclusionOur results showed adolescent psychosocial screening is only completed in 1 in 4 young people. The proportion of completed screening was higher in young people presenting with mental health problems compared to those with other presentations. These differences remain when partially completed screens are included. Some parts of the assessment were more frequently completed than others. Barriers to use by admitting clinicians included factors relating both to clinician knowledge and skills, and the hospital environment. These results will assist in clinician training as well as quality improvement for young people admitted to hospital.

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