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End of life care in paediatric settings: UK national survey
Get PDFObjectives To describe end of life care in settings where, in the UK, most children die; to explore commonalities and differences within and between settings; and to test whether there are distinct, alternative models of end of life care. Methods An online survey of UK neonatal units (NNUs), paediatric intensive care units (PICUs) and children/young people's cancer principal treatment centres (PTCs) collected data on aspects of service organisation, delivery and practice relevant to end of life outcomes or experiences (referred to as the core elements of end of life care) across three domains: care of the child, care of the parent and bereavement care. Results 91 units/centres returned a survey (37% response rate). There was variation within and between settings in terms of whether and how core elements of end of life care were provided. PTCs were more likely than NNUs and PICUs to have palliative care expertise strongly embedded in the multidisciplinary team (MDT), and to have the widest range of clinical and non-clinical professions represented in the MDT. However, bereavement care was more limited. Many settings were limited in the practical and psychosocial-spiritual care and support available to parents. Conclusions Children at end of life, and families, experience differences in care that evidence indicates matter to them and impact outcomes. Some differences appear to be related to the type of setting. Subsequent stages of this research (the ENHANCE study) will investigate the relative contribution of these core elements of end of life care to child/parent outcomes and experiences
Achieving the UN Sustainable Development Goal 6 in Nigeria: Lessons from Bangladesh’s ‘Nature Based Solution’ Approach
No full textThe United Nations Sustainable Development Goal (SDG) No. 6 is about ensuring adequate and quality water for all by 2030. However, there are concerns that Nigeria will not achieve SDG 6 as its efforts to ensure quality water have proved abortive. Nigeria does not recognize the people’s access to potable water as a constitutional right either. Bangladesh, one of the UNSDGs’ Global Champions, is a successful case study. There is, of course, a shortage of drinkable water in Bangladesh due to problems like those of Nigeria. Still, the country’s governmental actions, laws, and policies promote a Nature Based Solution (NBS) which includes eco-friendly strategies such as rainwater harvesting and other eco-sustainable approaches to conservation that benefit both human beings and the environment. Most importantly, it puts the people at the forefront of all conservation efforts. In this paper, we propose to examine the laws, regulations, and strategies that bring both Bangladesh’s people and nature into one collective action and consider whether Nigeria could use it to redress its communities’ lack of potable water. We argue that Bangladesh’s NBS approach should be seen, with some structural and cultural precautions, as the most sensible strategy for Nigeria, if the country is willing to achieve SDG 6 by 2030
Community Waterscapes: Uncovering tangible and intangible heritage of watery landscapes through community engagement in the Hull region
No full textExcerpt:Community Waterscapes, funded by the University of Hull and supported by Hull Maritime, the Living with Water Partnership and an endorsed action of the UN Decade of Ocean Science for Sustainable Development, is carrying out community-driven research to record tangible and intangible heritage that demonstrates people’s connection to water. The project addresses the urgent need to safeguard maritime heritage by partnering with communities who are living by watery environments, and facing water challenges, to better integrate cultural and environmental awareness of maritime landscapes. This has resulted in greater community agency surrounding the identification and safeguarding of local heritage, generating a dialogue around how and what future heritage should be protected
Optimisation of the preparation phase for orthopaedic surgery: Study protocol for a student-led multimodal prehabilitation feasibility trial (BoneFit)
Get PDFBackground Since the Covid-19 pandemic, a surgical backlog for total hip replacement (THR) and total knee replacement (TKR) surgery remains in the United Kingdom. Multimodal prehabilitation pathways (encompassing exercise, nutritional support and psychological wellbeing) can be utilised to ‘optimise” physical and mental resilience prior to the challenge of surgical intervention. BoneFit is an open-label, non-randomised feasibility trial to determine the recruitment and attendance/adherence rates, delivery and implementation challenges, fidelity, acceptability, and safety of a student-led multimodal prehabilitation intervention in people listed for THR/TKR surgery. We will also determine participant and clinician views of the intervention, and identify any challenges and enablers of inter-institutional partnership working. Methods Individuals listed for THR/TKR surgery aged between 18 to 75 years will be assigned to an intervention (n = 25) or usual-care control group (n = 25). The primary outcome measures will be feasibility of delivering the BoneFit intervention. Physical, psychological, quality of life and clinical outcomes will be assessed at three major time-points; T1 (baseline; 2 months from surgery), T2 (2–10 days from surgery), and T3 (3 months following surgery). We aim to show that the trial is feasible and that we can identify a signal of efficacy based on clinical outcomes collected compared to controls. The study was ethically approved by the Health Research Authority (London Bridge Research Ethics Committee: REC reference: 24/PR/ 0092) in March 2024. Discussion The development of a multimodal prehabilitation pathway could improve the physical and mental resilience of individuals awaiting orthopaedic surgery. We aim to determine if this translates to faster discharge and reduced complication rates, thus helping boost surgical throughput and potentially easing surgical backlog. It is likely that the concept of ‘waiting’ lists for surgery should be challenged, rather, individuals should be encouraged to use the time available to ‘prepare’ for surgery
Role of Serotonin in crayfish anxiety and anti-predatory behaviour
Get PDFEncountering threatening situations is a common occurrence in the living world. When exposed to danger for extended periods, behavioural response manifests as stress-induced sustained alertness, which is known as anxiety. It is essential to understand that anxiety can have long-lasting effects on an organism’s normal behaviour and interactions. This thesis aims to understand the role of serotonin in stress responses among crayfish. Crayfish are a keystone species in an aquatic ecosystem. Changes in their behaviour can negatively affect their inter- and intra-specific interactions. This can disrupt their role in the normal functioning of the ecosystem. The research involves three studies targeting stress under different conditions: exposure to low pH, the presence of fluoxetine, and injection of exogenous serotonin, dopamine, and their blockers. The first study focuses on the impact of freshwater acidification on crayfish response to alarm order (blood from conspecifics), and if this response is mediated via serotonin. The study reports that animals exposed to pH6 exhibit a significantly reduced behavioural response to alarm odour compared to the control (pH8) group. In addition, the animals do not show an elevated level of haemolymph glucose. The latter is mediated via the Crustacean Hyperglycaemic Hormone (CHH) which has been linked to serotonin changes and is an indicator of stress. The study shows that freshwater acidification can impair crayfish olfaction, leading to reduced anti-predatory responses and the behavioural response may be influenced by serotonin. The second study investigates the impact of fluoxetine, a pharmaceutically active compound (PhAC), on anxiety response in crayfish. Fluoxetine is an SSRI (Selective Serotonin Reuptake Inhibitor) which elevates serotonin levels by preventing its reuptake in the synapse. Animals were exposed to three different levels of fluoxetine (high, low, and intermediate doses) and exhibited an anxious response by spending more time with slower active speeds in the dark zones of the plus-maze behaviour setup when compared to controls. The crayfish that were exposed to Fluoxetine had elevated haemolymph glucose levels which suggested that serotonin is involved in the anxiogenic response. The study highlights the potentially harmful effects of pharmaceuticals in freshwater ecosystems, including changes in behaviour that can impact survival sustainability, and species interaction. The final study took a more direct approach regarding the impact of serotonin on crayfish anxiety-like behaviour (ALB). Animal groups were injected with physiological saline, serotonin, and dopamine at 2 doses each (1 μM and 10 μM) alone and in combination with their respective blockers (50 μM maleate salt and 10 μM methergine), in the pericardial sinus. Dopamine at 10 μM dose while serotonin at both tested concentrations, caused ALB among crayfish. The anxiogenic effect was successfully blocked when administered with either of the blockers. However, 1 μM dose of Dopamine did not affect behaviour but it appeared to have an anxiogenic effect when administered with methergine. Overall, our results emphasize the involvement of a complex functional interplay among biogenic amines in ALB in crayfish with blockers showing effects on more than one biogenic amine. It also leaves an open-ended question on the role of dopamine in anxiety responses which needs to be further investigated
Can Tissue-On-Chip Technology provide a platform for investigating differences in Extracellular Vesicle miRNA content between Thyroid Pathologies?
Get PDFThis study uses an established method to maintain human thyroid tissue ex vivo on a tissue-on-chip device, allowing for the collection, isolation and interrogation of the small extracellular vesicles (sEVs) released directly from thyroid tissue. The size and concentration of the sEVs from the thyroid tissue on chip effluent was analysed usingnanoparticle tracking analysis (NTA) (n=11) along with histoarchitectural integrity following both pre and post incubation on chip (n=16). sEVs were analysed for differences in miRNA levels released from euthyroid multinodular goitre (EMG), Graves’ disease (GD) and papillary thyroid cancer (PTC), using miRNA sequencing (miRNASeq) and quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) to identify potential biomarkers of disease. Thyroid biopsies from patients with EMG (n = 5), GD (n= 5) and PTC (n = 5) were perfused with medium containing sEV-depleted serum for 6 days on the tissue-on-chip device. All the effluents were collected and ultracentrifuged to isolate sEVs; miRNA was extracted and sequenced. Out of the 15 samples, 14 passed the quality control and miRNASeq analysis detected significantly higher expression of miR-375-3p, miR-7-5p, miR-382-5p and miR-127-3p in the sEVs isolated from GD tissue compared to those from EMG (false discovery rate; FDR < 0.05). Similarly, miR-375-3p and miR-7-5p were also detected at a higher level in the GD tissue sEVs compared to the PTC tissue sEVs (FDR < 0.05). No significant differences were observed between sEV miRNA from PTC vs. EMG. These results were supported by RT-qPCR. The novel findings demonstrate that the tissue-on-chip technology is a robust method for isolating sEVs directly from the tissue of interest. This has permitted the identification of four miRNAs, which through further investigation could be used as biomarkers or therapeutic targets within thyroid disease. Further works will look to validate these findings in patient serum samples with the long-term aim of developing a non-invasive liquid biopsy to help diagnose and manage thyroid disease
A Computational Approach to Modelling Molecular Biosignatures
Get PDFThis thesis presents a new computational method to model molecular biosignatures, using quantum chemistry techniques. To begin complimenting high resolution studies such as JWST, the fundamental vibrational band (ν = 0 → 1) has been selected to model.Owing to the biosignature data availability issue, where in only key molecules such as water and methane have been extensively studied out of a potential 16,000+, a large scale approach is needed. Most current computational methods are either high accuracy but with the caveat of a large computational and temporal cost or utilise simpler methodology but have potentially low accuracy.This project introduces an intermediate method which marries theory from both methods. This allows the production of an approximate methodology that is low in cost but of higher accuracy than simpler methods such as harmonic. This intermediate method utilises TOSH theory, and introduces the novel concept of using the anharmonic shift parameter σ to anharmonically correct the molecular geometry. This in turn allows the calculation for the vibrational excited rotational constants.This work has produced three new codes, Prometheus, Epimetheus and Pandora. Prometheus calculates the spectroscopic parameters and uses an internal simple modelling process to produce spectra. Epimetheus extends further than Prometheus and can calculate the spectroscopic constants for triatomic molecules. Finally, Pandora produces spectra for asymmetric triatomic molecules.It has been found this intermediate approach fairs well, typically producing data with a high-level approximation of the high-resolution databases such as HITRAN and ExoMol with some loss in accuracy for certain vibrational modes. Additionally this project has produced new data for isotopologues, which are currently not provided by other databases
Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study
Get PDFBackground: Through-knee amputation (TKA) has potential advantages over above-knee amputation (AKA) but is rarely performed in the United Kingdom (UK). This mixed methods study aimed to explore clinicians’ perceptions of TKA compared to AKA. Method: An online survey of vascular surgeons, prosthetists, and physiotherapists between May 2019 and April 2020. Follow-up semi-structured interviews explored themes from the survey. Thematic analysis was used to draw conclusions from the data. Results: Seventy-eight clinicians returned surveys, and follow-up interviews were completed with 21 clinicians. Reported advantages of TKA include its long lever and the femoral condyles to anchor (suspend) the prosthesis. Perceived disadvantages include poor wound healing and unsatisfactory prosthetic appearance. The interviews uncovered ineffective communication along the amputation pathway, contributing to a compartmentalised approach to amputation surgery and rehabilitation. Clinicians with strong feelings against TKA and a lack of desire/perceived ability to drive change from clinicians in favour of TKA are barriers to increasing its use. Conclusion: Current TKA surgery and rehabilitation practice is based on personal opinions, assumptions, or “accepted wisdom” and lacks an underpinning evidence base. Overall, opinions of TKA are divided, with conflicting views between different professional groups, highlighting the importance of multidisciplinary decision-making.Implications for rehabilitation Through-knee amputation has advantages and disadvantages compared to above-knee amputation which have been observed in clinical practice. Decision regarding level of amputation should involve multiple members of the multidisciplinary team. Lack of amputation pathway guidance and communication barriers prevent effective multidisciplinary collaboration
UK Preconception Partnership response to the consultation on the NICE guideline on Maternal and child nutrition
Get PDFIntroduction to Guideline:This guideline covers nutrition and weight management in pregnancy for anyone who may become pregnant, is planning to become pregnant or is already pregnant, and nutrition in children up to 5 years. Care of babies and children born preterm or with low birth weight is not covered. The guideline does not give detailed advice on what constitutes a healthy diet