Children's engagement and caregivers' use of language-boosting strategies during shared book reading: A mixed methods approach

For shared book reading to be effective for language development, the adult and child need to be highly engaged. The current paper adopted a mixed-methods approach to investigate caregiver's language-boosting behaviours and children's engagement during shared book reading. The results revealed there were more instances of joint attention and caregiver's use of prompts during moments of higher engagement. However, instances of most language-boosting behaviours were similar across episodes of higher and lower engagement. Qualitative analysis assessing the link between children's engagement and caregiver's use of speech acts, revealed that speech acts do seem to contribute to high engagement, in combination with other aspects of the interaction.

The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres

PURPOSE

To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.

METHODS

UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.

RESULTS

All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.

CONCLUSIONS

UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.

Exploring the different cognitive, emotional and imaginative experiences of autistic and non-autistic adult readers when contemplating serious literature as compared to non-fiction

Introduction

Recent research has demonstrated how reflections on serious literature can challenge dominant social-deficit views of autism. This method enables autistic readers to explore social realities more slowly and carefully, encouraging detail-focused considerations. Previous research has also shown that autistic and non-autistic readers reflecting on serious literature together are able to achieve mutuality in a way that enables them to overcome the double empathy problem. However, the advantages of reading aloud designs have yet to be explored with autistic and non-autistic readers due to previous concerns amongst autistic people on the issue of being read aloud to. The present study aimed to explore how an adapted shared reading design that compared serious literature and non-fiction would enable autistic and non-autistic readers to imaginatively engage in the reading experience.

Methods

Seven autistic and six non-autistic participants read 8 short text extracts alone while listening to pre-recorded audio of an experienced reader reading each text aloud. Participants completed a reflective questionnaire for each text and a follow-up interview where moving parts of the text were then re-read aloud before discussion. Half of these texts were serious literature, while the other half were non-fiction. Similarly, half of the texts explored fictional social realities that depicted a lack of mutuality, or non-fiction accounts of autism; while the other half explored broader emotional experiences.

Results

Thematic and literary analysis of participant reflections and follow-up interviews revealed three main themes: (1) From Surface Reading to Intuitive Engagement, (2) Imaginative Feeling and (3) Going Forward from the Reading Experience.

Discussion

The findings showed that autistic readers were better able to hold onto the detailed complexity of serious literature, while non-autistic readers tended to reduce information down to key ideas and understandings for later generalization. Findings are discussed in relation to future shared reading designs.

Come together: The importance of arts and cultural engagement within the Liverpool City Region throughout the COVID-19 lockdown periods

Introduction

Arts and cultural engagement activities have long been found to support wellbeing within the general population. In particular, community arts and cultural involvement during the COVID-19 pandemic have been an invaluable source of mental health and wellbeing support for many individuals across the globe. The initial move to remote engagement following the first United Kingdom lockdown demonstrated the importance of hybrid provisions, with isolated and vulnerable individuals finding online provisions important for wellbeing. With restrictions on movement and service access in the United Kingdom having gradually eased from March 2021, it is now important to explore how individuals navigated the ability to engage with either remote or in-person provisions. The current study aimed to explore the impact of the COVID-19 pandemic on arts and cultural engagement during periods of restrictions and initial easings on movement within the Liverpool City Region.

Method

The study consisted of two waves of qualitative interviews within a broader longitudinal study. Twelve interviews were conducted during wave 1, which aimed to capture data during the initial COVID-19 lockdown period and the initial easing of restrictions. Eight of these participants were interviewed again for wave 2, which aimed to capture data during the winter 2020 lockdown period.

Results

Framework analysis revealed three overarching themes: (1) The Importance of Arts and Culture for Personal Enrichment, (2) Belongingness through Socialization, and (3) Transitioning and Adjusting Throughout the COVID-19 Pandemic.

Discussion

Findings presented in the current study provide further evidence of the value of arts and cultural activities in supporting wellbeing. Specifically, the current data emphasize the value of arts and cultural engagement throughout the COVID-19 pandemic and particularly during times of national restriction. Furthermore, the current study demonstrated that remote engagement provided important wellbeing support throughout the pandemic in a way that protected against mental health consequences, but with limitations on feelings of social connectedness within online environments. Amidst continuing risks from the COVID-19 virus and feelings of uncertainty, this study highlights the importance of hybrid provisions.

Back to live: Returning to in-person engagement with arts and culture in the Liverpool City Region

On July 19th 2021, the UK government lifted the COVID-19 restrictions that had been in place since March 2020, including wearing masks, social distancing, and all other legal requirements. The return to in-person events has been slow and gradual, showing that audiences are still cautious when (and if) they resume engaging in arts and culture. Patterns of audience behavior have also changed, shifting toward local attendance, greater digital and hybrid engagement, and openness to event format changes. As the arts and cultural industry recovers from the pandemic, it is important to adopt an audience-oriented approach and look at the changing patterns of engaging in arts and culture. This study aims to better understand the impact of the pandemic on the patterns of cultural and arts engagement. Eight qualitative interviews were conducted to explore the changes in arts and cultural engagement since the restrictions were lifted, focusing particularly on the audience’s experiences of returning to in-person arts and cultural events in the Liverpool City Region (LCR). Using framework analysis, three themes were identified from the data: The new normal: reframing pre-pandemic and pandemic experiences of arts and culture, Re-adjusting to in-person provision, and Moving forward: online and blended provision. The findings show that the pandemic altered the ways that people engage in arts and culture. The “new normal,” a blend of pandemic and pre-pandemic experiences, illustrates how the pandemic has highlighted and reconfigured the importance of arts and culture, in terms of personal and cultural identity. Resuming in-person engagement after a long break, participants noted that they were able to feel more like themselves again. Arts and culture were perceived to be beneficial in rebuilding personal resilience and confidence. Engaging in arts and culture, following the isolating experience of the pandemic, has also helped participants feel reconnected to others through their shared experiences. Finally, the findings suggest that online provision remains vital for many, ensuring wider inclusivity, particularly for vulnerable audiences. At the same time, it is important to acknowledge the barriers to online inclusion and the possibility of this resulting in a growing digital divide.

Lifting lockdown: Renewed access to arts and cultural activities

BACKGROUND

The effects of COVID-19 on mental health are profound. While there is a growing body of evidence on arts supporting mental health, the re-engagement with in-person arts and cultural activity has remained slow following the lifting of restrictions.

METHODS

Interviews with 14 representatives, including providers and practitioners, from 12 arts and cultural organisations within the Liverpool City Region (LCR) were conducted. The aim was to examine the impact of COVID-19 restrictions easing on arts and cultural provision in the LCR, and on the mental health and wellbeing of those whom arts and cultural organisations serve, including those who would usually access arts through formal healthcare routes (e.g., those usually served via arts organisations' partnership with health or social care providers). Data were analysed using framework analysis.

RESULTS

Three overarching themes were identified: The new normal: 'Out of crisis comes innovation'; Complexities of operating 'in the new COVID world'; and Reimagining arts in mental healthcare.

CONCLUSION

As engagement in community and cultural activities plays a public health role, a hybrid delivery of arts and culture - ensuring continued online access alongside in-person provision - will be vital for people's recovery. Alongside efforts to reimagine arts in mental healthcare in the wake of the crisis caused by the pandemic, the role of arts and culture in providing stigma-free environments to reconnect the vulnerable and isolated is more critical than ever. Recommendations on the role of arts and culture in sustaining the mental health and wellbeing of the population and embedding the arts within clinical care and public health prevention schemes are provided.

Regional Innovation in Arts Provision Spawned by COVID-19: “It Became a Lifeline for a Lot of People Who Are Stuck at Home”

Although the impact of the global COVID-19 pandemic on the arts and cultural sector due to the closure of galleries, museums, arts venues, and other cultural assets represents a significant health risk, new opportunities for arts and cultural engagement have arisen. Interviews with 24 representatives including service providers and creative practitioners from 15 arts and cultural organizations within the Liverpool City Region were conducted. The aim was to examine the impact of COVID-19 on arts and cultural provision and on organizations and people providing these services, as well as to understand the perceptions of service providers and practitioners of the effects on those whom arts and cultural organizations serve, including those who would usually access arts through formal healthcare routes (e.g., through collaboration with health partners). Interview data were analyzed using framework analysis. Four overarching themes were identified: Response: Closures, adaptations, and new directions; Challenges of online provision; Value of online provision; and the future of the arts. The arts and cultural sector has innovated rapidly, notably with accelerated digitalisation. Alternative provision has been “a lifeline” for vulnerable groups, such as those with mental health difficulties. Arts organizations have been most effective in reaching vulnerable, isolated and disadvantaged populations when they have worked in close collaboration with health and social care providers. The implementation of hybrid provision is an important move forward for the sector in light of our findings that alternative modes of provision are advantageous additions to service as usual. Given the increasing concerns about the mental health sequelae of the pandemic in the UK, arts and cultural engagement could play a pivotal role in the future recovery period.

Challenging Empathic Deficit Models of Autism Through Responses to Serious Literature

Dominant theoretical models of autism and resultant research enquiries have long centered upon an assumed autism-specific empathy deficit. Associated empirical research has largely relied upon cognitive tests that lack ecological validity and associate empathic skill with heuristic-based judgments from limited snapshots of social information. This artificial separation of thought and feeling fails to replicate the complexity of real-world empathy, and places socially tentative individuals at a relative disadvantage. The present study aimed to qualitatively explore how serious literary fiction, through its ability to simulate real-world empathic response, could therefore enable more ecologically valid insights into the comparative empathic experiences of autistic and non-autistic individuals. Eight autistic and seven non-autistic participants read Of Mice and Men for six days while completing a semi-structured reflective diary. On finishing the book, participants were asked to engage in three creative writing tasks that encouraged reflective thinking across the novel. Thematic and literary analysis of the diary reflections and writing tasks revealed three main themes (1) Distance from the Novel; (2) Mobility of Response; (3) Re-Creating Literature. Findings demonstrated the usefulness of serious literature as a research tool for comparing the empathic experiences of autistic and non-autistic individuals. Specifically, autistic individuals often showed enhanced socio-empathic understandings of the literature with no empathy deficits when compared to non-autistic participants.

An analysis of the reading habits of autistic adults compared to neurotypical adults and implications for future interventions

BACKGROUND

While research has consistently highlighted the usefulness of narrative texts for social development, this has not been fully explored with autistic adults. It has long been assumed that autistic individuals lack the social understanding to contemplate fiction, preferring non-fiction. This study aimed to explore the self-reported reading habits of autistic adults compared to neurotypical adults, accounting for higher education demands.

METHODS

A qualitative design was used, with 43 participants (22 autistic; 21 neurotypical) completing a reading habits questionnaire and subsequent semi-structured interview.

RESULTS

Neurotypical participants tended to prefer fiction, with autistic participants showing no preference between fiction and non-fiction. Four themes were identified from interview data (1) reading material choices; (2) text investment; (3) in-text social understanding; and (4) reading as a social learning device. Both groups reported evidence of empathising, perspective-taking and social understanding while reading. The autistic group additionally reported social learning outcomes from reading.

DISCUSSION

Findings contradict prior assumptions that autistic individuals lack the social understanding required by fiction. Instead, findings show that social benefits of narrative texts extend to autistic readers, providing important social learning experiences.

Overcoming the Double Empathy Problem Within Pairs of Autistic and Non-autistic Adults Through the Contemplation of Serious Literature

Recent research based on the needs of the autistic community has explored the frequent social misunderstandings that arise between autistic and non-autistic people, known as the double empathy problem. Double empathy understandings require both groups to respect neurodiversity by focussing on individuality across groups. This study aimed to explore how literature, through its ability to uncover nuanced emotional response differences between readers, could facilitate double empathy understandings within pairs of autistic and non-autistic adults. A longitudinal, qualitative design was used, with 4 gender-matched pairs. Participants read Of Mice and Men for 1 week, whilst completing a structured, reflective diary. This was followed by 4 one-hour paired reading sessions, where pairs discussed the book and their reflections in depth. Participants were then invited to a final one-on-one interview to discuss their thoughts and experiences of the paired reading sessions. Thematic and literary analysis of the session and interview data revealed four themes (1) The Book as Social Oil; (2) From a World of Difference to a World of Affinity; (3) Emotional Intelligence: From Thinking About to Feeling with; and (4) From Overwhelming to Overcoming. All participants reported having achieved an individualised view of one another to explore their nuanced differences. The non-autistic group reported a more sensitive understanding of what it means to be autistic, while the autistic group overcame concerns about non-autistic people stereotyping autism, and instead reported feeling valued and accommodated by their non-autistic partners.

The (Under)Use of Eye-Tracking in Evolutionary Ecology

To survive and pass on their genes, animals must perform many tasks that affect their fitness, such as mate-choice, foraging, and predator avoidance. The ability to make rapid decisions is dependent on the information that needs to be sampled from the environment and how it is processed. We highlight the need to consider visual attention within sensory ecology and advocate the use of eye-tracking methods to better understand how animals prioritise the sampling of information from their environments prior to making a goal-directed decision. We consider ways in which eye-tracking can be used to determine how animals work within attentional constraints and how environmental pressures may exploit these limitations.

Mirror neuron system activation in children with developmental coordination disorder: A replication functional MRI study

BACKGROUND

It has been hypothesised that abnormal functioning of the mirror neuron system (MNS) may lead to deficits in imitation and the internal representation of movement, potentially contributing to the motor impairments associated with developmental coordination disorder (DCD).

AIMS

Using fMRI, this study examined brain activation patterns in children with and without DCD on a finger adduction/abduction task during four MNS activation states: observation; motor imagery; execution; and imitation.

METHODS AND PROCEDURES

Nineteen boys (8.25-12.75 years) participated, including 10 children with DCD (≤16th percentile on MABC-2; no ADHD/ASD), and nine typically developing controls (≥25th percentile on MABC-2).

OUTCOMES AND RESULTS

Even though children with DCD displayed deficits behaviourally on imitation (Sensory Integration & Praxis Test Subtests) and motor imagery assessments prior to scanning, no differences in MNS activation were seen between the DCD and control groups at a neurological level, with both groups activating mirror regions effectively across conditions. Small clusters of decreased activation during imitation were identified in non-mirror regions in the DCD group, including the thalamus, caudate, and posterior cingulate - regions involved in motor planning and attentional processes.

CONCLUSIONS AND IMPLICATIONS

The results of this study do not provide support for the MNS dysfunction theory as a possible causal mechanism for DCD. Further research to explore attentional and motor planning processes and how they may interact at a network level may enhance our understanding of this complex disorder.

A comparative study of cognitive behavioural therapy and shared reading for chronic pain

The case for psychosocial interventions in relation to chronic pain, one of the most common health issues in contemporary healthcare, is well-established as a means of managing the emotional and psychological difficulties experienced by sufferers. Using mixed methods, this study compared a standard therapy for chronic pain, cognitive behavioural therapy (CBT), with a specific literature-based intervention, shared reading (SR) developed by national charity, The Reader. A 5-week CBT group and a 22-week SR group for patients with chronic pain ran in parallel, with CBT group members joining the SR group after the completion of CBT. In addition to self-report measures of positive and negative affect before and after each experience of the intervention, the 10 participants kept twice-daily (12-hourly) pain and emotion diaries. Qualitative data were gathered via literary-linguistic analysis of audio/video-recordings and transcriptions of the CBT and SR sessions and video-assisted individual qualitative interviews with participants. Qualitative evidence indicates SR's potential as an alternative or long-term follow-up or adjunct to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by patients with chronic pain. In addition, quantitative analysis, albeit of limited pilot data, indicated possible improvements in mood/pain for up to 2 days following SR. Both findings lay the basis for future research involving a larger sample size.

A literature-based intervention for women prisoners: preliminary findings

Purpose

The purpose of this paper is to investigate whether Shared Reading (SR), a specific literature-based intervention, is transposable to a prison context and whether mental health benefits identified in other custodial and non-custodial settings were reported by women prisoners.

Design/methodology/approach

In all, 35 participants were recruited within an all-female maximum security prison and attended one of two weekly reading groups. Qualitative data were collected through researcher observation of the reading groups; interviews and focus group discussions with participants and prison staff; interviews with the project worker leading the reading groups; and a review of records kept by the latter during group sessions.

Findings

Attendance rates were good, with nearly half of the participants voluntarily present at =60 per cent of sessions. Two intrinsic psychological processes associated with the SR experience were provisionally identified, “memory and continuities” and “mentalisation”, both of which have therapeutic implications for the treatment of conditions like depression and personality disorder.

Research limitations/implications

Limitations included the small sample, lack of control for confounding variables, and constraints imposed on data collection by the custodial setting.

Originality/value

Although more controlled research is required, the findings indicate that women prisoners will voluntarily engage with SR if given appropriate support, and that the intervention has potential to augment psychological processes that are associated with increased well-being.

Shared Reading: assessing the intrinsic value of a literature-based health intervention

Public health strategies have placed increasing emphasis on psychosocial and arts-based strategies for promoting well-being. This study presents preliminary findings for a specific literary-based intervention, Shared Reading, which provides community-based spaces in which individuals can relate with both literature and one another. A 12-week crossover design was conducted with 16 participants to compare benefits associated with six sessions of Shared Reading versus a comparison social activity, Built Environment workshops. Data collected included quantitative self-report measures of psychological well-being, as well as transcript analysis of session recordings and individual video-assisted interviews. Qualitative findings indicated five intrinsic benefits associated with Shared Reading: liveness, creative inarticulacy, the emotional, the personal and the group (or collective identity construction). Quantitative data additionally showed that the intervention is associated with enhancement of a sense of 'Purpose in Life'. Limitations of the study included the small sample size and ceiling effects created by generally high levels of psychological well-being at baseline. The therapeutic potential of reading groups is discussed, including the distinction between instrumental and intrinsic value within arts-and-health interventions.

"Shall I compare thee": The neural basis of literary awareness, and its benefits to cognition

Functional magnetic resonance imaging (fMRI) was used to explore the neural and cognitive basis of literary awareness in 24 participants. The 2×2 design explored the capacity to process and derive meanings in complex poetic and prosaic texts that either did or did not require significant reappraisal during reading. Following this, participants rated each piece on its 'poeticness' and the extent to which it prompted a reappraisal of meaning during reading, providing subjective measures of poetic recognition and the need to reappraise meaning. The substantial shared variance between these 2 subjective measures provided a proxy measure of literary awareness, which was found to modulate activity in regions comprising the central executive and saliency networks. We suggest that enhanced literary awareness is related to increased flexibility of internal models of meaning, enhanced interoceptive awareness of change, and an enhanced capacity to reason about events. In addition, we found that the residual variance in the measure of poetic recognition modulated right dorsal caudate activity, which may be related to tolerance of uncertainty. These findings are consistent with evidence that relates reading to improved mental wellbeing.

A literature-based intervention for older people living with dementia

Background:

While several studies have explored the impact of literature and reading on mental health, there has been relatively little work done on how a literature-based intervention might impact on the behaviours of those living with dementia. The present report addresses the effect that a specific literature-based intervention – Get into Reading, designed and practised by national charity The Reader Organisation – might have on the health and well-being of people living with dementia.

Aims:

This present study arises out of a service evaluation that specifically assessed to what extent the shared-reading intervention impacted upon behaviours symptomatic of dementia. Its aims were: (1) to understand the influence that reading has on older adults with dementia in different health-care environments; (2) to identify staff perceptions of the influence that engagement in a reading group has on older adults living with dementia; and (3) to investigate any changes in dementia symptoms of older adults participating in a reading group.

Methods:

The study employed a mixed-method design conducted within three health-care environments: three care homes, two hospital wards and one day centre. The Neuropsychiatric Inventory Questionnaire (NPI-Q) assessed staff views of any changes in dementia symptom severity for participants in reading groups conducted in the care homes. Semi-structured qualitative interviews were then conducted with staff who attended the reading groups and/or had extensive knowledge of service users involved in all of the health-care settings. Responses to questions were recorded verbatim and then subject to thematic analysis.

Results:

61 service users and 20 staff members took part in the overall project. The NPI-Q results indicate that symptom scores were lower during the reading group period than at baseline. These findings were supported by the qualitative interviews, which suggested that three themes were perceived to be important to effective engagement with the reading groups: (1) the components of the reading group intervention; (2) enjoyment, authenticity, meaningfulness and renewed sense of personal identity; and (3) enhancement of listening, memory and attention.

Conclusions:

In light of quantifiable data of limited but indicative status, together with strongly corroborative qualitative evidence, engagement in reading-group activity appeared to produce a significant reduction in dementia symptom severity. Staff interviews indicated the contribution of reading groups to well-being.

Get into Reading as an intervention for common mental health problems: exploring catalysts for change

There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a validated severity measure. Data collection included quantitative measures at the outset and end of the study, digital recording of sessions, observation and reflective diaries. Qualitative data were analysed thematically and critically compared with digital recordings. The evidence suggested a reduction in depressive symptoms for Get into Reading group participants. Three potential catalysts for change were identified: literary form and content, including the balance between prose and poetry; group facilitation, including social awareness and communicative skills; and group processes, including reflective and syntactic mirroring. This study has generated hypotheses about potential change processes of Get into Reading groups. Evidence of clinical efficacy was limited by small sample size, participant attrition and lack of controls. The focus on depression limited the generalisability of findings to other clinical groups or in non-clinical settings. Further research is needed, including assessment of the social and economic impact and substantial trials of the clinical effectiveness and cost-effectiveness of this intervention.

Stability of a receptor-binding active human immunodeficiency virus type 1 recombinant gp140 trimer conferred by intermonomer disulfide bonding of the V3 loop: differential effects of protein disulfide isomerase on CD4 and coreceptor binding

Stable trimeric forms of human immunodeficiency virus recombinant gp140 (rgp140) are important templates for determining the structure of the glycoprotein to assist in our understanding of HIV infection and host immune response. Such information will aid the design of therapeutic drugs and vaccines. Here, we report the production of a highly stable and trimeric rgp140 derived from a HIV type 1 (HIV-1) subtype D isolate that may be suitable for structural studies. The rgp140 is functional in terms of binding to CD4 and three human monoclonal antibodies (17b, b12, and 2G12) that have broad neutralizing activities against a range of HIV-1 isolates from different subtypes. Treatment of rgp140 with protein disulfide isomerase (PDI) severely restricted 17b binding capabilities. The stable nature of the rgp140 was due to the lack of processing at the gp120/41 boundary and the presence of an intermonomer disulfide bond formed by the cysteines of the V3 loop. Further characterization showed the intermonomer disulfide bond to be a target for PDI processing. The relevance of these findings to the roles of the V3 domain and the timing of PDI action during the HIV infection process are discussed.

Complement regulation at the molecular level: the structure of decay-accelerating factor

The human complement regulator CD55 is a key molecule protecting self-cells from complement-mediated lysis. X-ray diffraction and analytical ultracentrifugation data reveal a rod-like arrangement of four short consensus repeat (SCR) domains in both the crystal and solution. The stalk linking the four SCR domains to the glycosylphosphatidylinositol anchor is extended by the addition of 11 highly charged O-glycans and positions the domains an estimated 177 A above the membrane. Mutation mapping and hydrophobic potential analysis suggest that the interaction with the convertase, and thus complement regulation, depends on the burial of a hydrophobic patch centered on the linker between SCR domains 2 and 3.