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The meaning of “total pain” in the context of living and dying with dementia
Get PDFBackground: Globally, there are 55 million people living with dementia (PLWD). PLWD have an uncertain prognosis. Most are approaching the end of life but are not overtly or immediately dying. Contemporary approaches to dementia care therefore promote the need to live and die well with dementia. Pain is highly prevalent but difficult to manage in PLWD. Originating in palliative care, “total pain” conceives of pain holistically, incorporating biological, psychological, social and spiritual elements. Pain management in dementia care tends to be pharmacologically focused. Total pain therefore offers an alternative approach—one consistent with person-centred philosophy underpinning contemporary dementia care. Due to important differences, concepts cannot simply be extrapolated from cancer-related to dementia-related palliative care however. Dementia-specific approaches are needed and require exploration.Description and objective of the analysis: The objective of this paper is to explore the meaning of total pain in the context of living and dying with dementia, and its utility and implications for person-centred dementia care. Using a palliative care framework and existing literature, we critically consider the bio-psycho-socio-spiritual impact of dementia, to explore how total pain might manifest and be experienced in this context.Findings and interpretation: We highlight the complexity, nuance and socially contingent nature of the impact of living and dying with dementia. We challenge binary understandings of “continuity or loss” (e.g., of identity, relationships), and totalising “loss” discourses, demonstrating that more subtle, varied and hopeful outcomes are possible. The way that the impact of dementia is articulated and understood has implications for the experience and management of total pain. The deficit-orientation of “total pain” paradoxically risks its perpetuation. A balanced understanding of dementia’s impact (acknowledging both continuity and loss, alternatives and socially constructed aspects) better reflects the realities of dementia and creates new possibilities for supportive care practices to improve pain management and quality of life.Conclusion and implications for practice: Applied to dementia care, “total pain” should be located within a critical context, emphasising complexity, contingency and nuance. The holistic focus of “total pain” should be extended to incorporate balanced consideration of “painful” and “functional” experience. We introduce a balanced model of total pain incorporating a dual focus on “pain” and “personhood” within a critical context, to facilitate translation to practice. There is a need to develop evidence-based supportive interventions in each domain of total pain, to support a balanced approach to total pain management in dementia care
Hepatocellular carcinoma surveillance: minimum standards
Get PDFHepatocellular carcinoma (HCC) is a rapidly growing cause of cancer-related deaths in the UK, with early detection being critical for improving survival rates. Despite clear guidelines recommending six- monthly surveillance for at-risk populations, participation remains low, with an estimated 20% of eligible patients attending regular surveillance. This guidance outlines the minimum standards for delivering effective HCC surveillance in the UK, emphasising the need for integrated patient tracking, digital call-recall systems and a multifaceted approach to engagement. Combining ultrasound with serum alpha-fetoprotein (AFP) improves detection rates, though AFP alone is insufficient due to its variability. The recommendations aim to increase surveillance adherence, enhance early diagnosis, and ultimately improve outcomes for patients at risk of HC
Structured reporting of gliomas based on VASARI criteria to improve report content and consistency
Get PDFPurpose: Gliomas are the commonest malignant brain tumours. Baseline characteristics on structural MRI, such as size, enhancement proportion and eloquent brain involvement inform grading and treatment planning. Currently, free-text imaging reports depend on the individual style and experience of the radiologist. Standardisation may increase consistency of feature reporting. Methods: We compared 100 baseline free-text reports for glioma MRI scans with a structured feature list based on VASARI criteria and performed a full second read to document which VASARI features were in the baseline report. Results: We found that quantitative features including tumour size and proportion of necrosis and oedema/infiltration were commonly not included in free-text reports. Thirty-three percent of reports gave a description of size only, and 38% of reports did not refer to tumour size at all. Detailed information about tumour location including involvement of eloquent areas and infiltration of deep white matter was also missing from the majority of free-text reports. Overall, we graded 6% of reports as having omitted some key VASARI features that would alter patient management. Conclusions: Tumour size and anatomical information is often omitted by neuroradiologists. Comparison with a structured report identified key features that would benefit from standardisation and/or quantification. Structured reporting may improve glioma reporting consistency, clinical communication, and treatment decisions
Deciphering the Anti-Listerial Activity and Phytochemical Composition of Licorice Root Extract Using LC-MS/MS in Combination with In Vitro and Computational Evaluations
Get PDFNatural products are an endless source of antimicrobial agents against many foodborne pathogenic bacteria. The present work demonstrates the potential of licorice root extract to efficiently inhibit the growth of a panel of Listeria strains and serotypes. Results support the utilization of the plant extract as a promising anti-Listeria agent for the food industry. Furthermore, it also demonstrates the combined use of advanced analytical and in silico methodologies to decode the active components of the extract, opening new horizons in the discovery of novel agents to control Listeria bacteria. Abstract: Licorice roots are a rich source of bioactive compounds with multiple biological activities. The objective of this study was to evaluate the inhibitory effects of licorice root extract against a range of Listeria strains. In addition, the correlation of its phytochemical composition with antimicrobial properties was also investigated. Thus, the bacteriostatic and bactericidal effects of licorice root extract on seven Listeria monocytogenes strains, L. grayi, L. seeligeri, and L. ivanovii were determined. The minimum inhibitory and bactericidal concentrations ranged from 31.3 to 62.5 µg mL −1 and from 62.5 to 250 µg mL −1 , respectively. The phytochemical composition of the extract was also analyzed using advanced LC-DAD-qTOF-MS; it is composed of fifty-one compounds belonging to different subgroups of flavonoids and triterpenoids. Subsequently, the anti-Listeria potency of the most abundant phytochemicals was determined using the AntiBac-Pred web tool. In silico calculation showed that liquiritin-apioside and licorice glycoside C1/C2 were strong growth inhibitors of L. monocytogenes, as their potency was comparable to well-known antibiotic substances. Overall, the present study demonstrates the potent antimicrobial effect of licorice root extract and reveals its active phytochemicals
High-fidelity wheat plant reconstruction using 3D Gaussian splatting and neural radiance fields
Get PDFBackgroundThe reconstruction of 3-dimensional (3D) plant models can offer advantages over traditional 2-dimensional approaches by more accurately capturing the complex structure and characteristics of different crops. Conventional 3D reconstruction techniques often produce sparse or noisy representations of plants using software or are expensive to capture in hardware. Recently, view synthesis models have been developed that can generate detailed 3D scenes, and even 3D models, from only RGB images and camera poses. These models offer unparalleled accuracy but are currently data hungry, requiring large numbers of views with very accurate camera calibration.ResultsIn this study, we present a view synthesis dataset comprising 20 individual wheat plants captured across 6 different time frames over a 15-week growth period. We develop a camera capture system using 2 robotic arms combined with a turntable, controlled by a re-deployable and flexible image capture framework. We trained each plant instance using two recent view synthesis models: 3D Gaussian splatting (3DGS) and neural radiance fields (NeRF). Our results show that both 3DGS and NeRF produce high-fidelity reconstructed images of a plant subject from views not captured in the initial training sets. We also show that these approaches can be used to generate accurate 3D representations of these plants as point clouds, with 0.74-mm and 1.43-mm average accuracy compared with a handheld scanner for 3DGS and NeRF, respectively.ConclusionWe believe that these new methods will be transformative in the field of 3D plant phenotyping, plant reconstruction, and active vision. To further this cause, we release all robot configuration and control software, alongside our extensive multiview dataset. We also release all scripts necessary to train both 3DGS and NeRF, all trained models data, and final 3D point cloud representations. Our dataset can be accessed via https://plantimages.nottingham.ac.uk/ or https://https://doi.org/10.5524/102661. Our software can be accessed via https://github.com/Lewis-Stuart-11/3D-Plant-View-Synthesis
Providing life-sustaining treatments at home for those with Motor Neurone Disease: A qualitative study of bereaved family members’ experiences of responsibility
Get PDFBackground: Motor neurone disease is an incurable neurodegenerative condition that progressively impairs motor function. It affects mobility, speech, swallowing and breathing, leading to significant dependence on others. Home mechanical ventilation can alleviate respiratory symptoms and improve survival. Aim: To examine the experiences of bereaved family members involved in the care of someone with motor neurone disease who had died with home mechanical ventilation in place, or following its withdrawal. Design: An interpretive constructivist approach was used to carry out qualitative interviews. Setting/participants: Bereaved family members from England and Wales whose relative had died with ventilation in place, or after withdrawal. Results: Thirty-six bereaved family members took part. Their experiences highlight the extensive responsibilities and emotional burdens of managing home mechanical ventilation. Family members reported feelings of heightened responsibility, distrust in the abilities of professional caregivers, significant impacts on their mental and physical well-being and the ways in which knowledgeable care providers could lift such responsibilities. Conclusions: As the use of technology to sustain life increases, we need to question how much we expect of family members in providing care for those with complex interventions, such as ventilation, at home. This research underscores the critical role family members’ play in home care for people with motor neurone disease and calls for a greater understanding of the impacts of maintaining responsibility for life-sustaining treatments. There is a need for better support and training for both family and professional caregivers to alleviate some of the responsibility placed upon family members
The Facile Synthesis of Exogenous Lewis-Base-Free Amidoalanes: A Structural Comparison
Get PDFA simple one-pot reaction of LiAlH4, AlCl3, and a secondary amine HNR2 [R = Et, iPr, iBu, cyclo-C6H11, (CH2)4, and (CH2)5] in hydrocarbon solvents results in the formation of exogenous Lewis-base-free amidoalanes [H2Al(NR2)]n (n = 2 or 3) as crystalline solids (35–85% yield). In the solid state (seven X-ray structures), all the amidoalanes exist as dimers, with the exception of the pyrrolidine-derived alane which exists as a trimer. As solids, these amidoalanes exhibit significant kinetic stability towards oxygen/moisture allowing the brief (ca. 5 min.) handling of [H2Al(NiPr2)]2 in air
A mixed methods protocol for an impact and implementation evaluation of the Pharmacy First Services for management of common conditions in England
Get PDFObjectivesIn response to high levels of demand for primary medical services in England, characterized by longer appointment waiting times and delayed referrals, the Government developed its National Health Service (NHS) Primary Care Recovery Plan. A key component of the plan is Pharmacy First (PF), which involves participating community pharmacies supplying prescription-only medicine after consultation with a pharmacist for seven common conditions: earache, uncomplicated urinary tract infections in women, sore throat, sinusitis, impetigo, shingles, and infected insect bites. The study aims to evaluate the implementation of the PF service and its impact on the volume of prescribing, case mix of General Practitioner consultations, accident and emergency department and other hospital use, equity of access, and cost for different groups of patients in different contexts, as well as its acceptability and fidelity.MethodsA 36-month, mixed methods evaluation with five elements, namely evidence synthesis, semi-structured interviews, focus groups, quantitative analysis of impacts before and after implementation (e.g. using interrupted time series analysis) using routine data, and an economic evaluation. Findings will be synthesized and interpreted using the Consolidated Framework for Implementation Research supplemented by Proctor’s Implementation Outcomes Framework.ConclusionsThe evaluation should have service level, policy, professional, and research impact both in England and beyond. This includes generating evidence to show: whether PF contributes to improving primary healthcare access, assessing the quality of antimicrobial use, identifying the scope for refinements to PF, and, overall, informing better implementation of PF. The findings will also provide robust evidence to enable policymakers to determine how to enhance the role of community pharmacy in England in the future. Furthermore, the evaluation will develop a data dashboard, and the methods and codes used to interrogate it (though not the patient data), will be made publicly available that could support other similar evaluations in England and internationally
AI4Green4Students: Promoting Sustainable Chemistry in Undergraduate Laboratories with an Electronic Lab Notebook
Get PDFAI4Green is an open-source, machine-learning-powered electronic laboratory notebook (ELN) developed to help chemists mitigate environmental impacts, particularly within the pharmaceutical sector. This study presents AI4Green4Students, a pedagogically adapted version designed to foster sustainable laboratory practices. The AI4Green4Students ELN includes features for sustainability assessment, data documentation, and analysis, aiming to equip students with skills for modern, sustainable laboratory practices. User feedback, gathered through questionnaires and interviews, informed the initial development and subsequent refinements of the application. Implementation in a Year 3 undergraduate chemistry lab project indicated improved adherence to sustainable practices, suggesting that the ELN supports the integration of sustainable chemistry into laboratory teaching. Future efforts will expand AI4Green4Students to include additional experiments to broaden its applicability across undergraduate chemistry courses, as well as integrate machine learning tools to enhance data analysis capabilities
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